Background:. The reported prevalence of sciatica ranges from 1.2% to 43%. Epidural injections are the most commonly performed interventions for sciatica. Setting:. A provincial based spinal unit. Objective:. To evaluate the effectiveness of lumbar epidural injections with local anaesthetic and steroids, in patients with sciatica secondary to disc herniation in providing effective pain relief. Methods:. A retrospective chart review of 25 patients given an epidural with local anaesthetic mixed with non-particulate betamethasone. Patient outcomes were measured at baseline and 6 weeks with the Oswestry Disability Index 2.0 (ODI). Observations of gender, sex, co-morbities and medication intake were made. Decrease of 50% in the Oswestry scores were considered significant. Results:. Significant pain relief was seen at 6 weeks in 80% of patients and medication intake was decreased. Limitations:. The study limitations include the lack of a placebo group and the fact that this is a preliminary report of the 25 patients. Conclusion:. Overall, 80% of patients with sciatica benefited from lumbar epidural injections

To investigate clinical outcome scores in surgically treated patients with either spontaneous or postoperative pyogenic spondylodiscitis after 3, 12 and 24 month. 70 consecutive patients (mean age 64y; male n=33 female n=27) underwent surgical treatment due to pyogenic spondylodiscitis with or without epidural abscess at our department from 2011 to 2013. We performed either microsurgical debridement or debridement in combination with ventral support employing dorsally instrumented spondylodesis followed by bracing and antibiotic therapy up to 12 weeks. European life quality score (EQ-5D), Oswestry disability index (ODI) and visual analogue scale for pain (VAS) were recorded 3, 12 and 24 month after surgery. Length of hospital stay (LOS) was 25,3 days. The Mean time to presentation at our spine center and diagnosis was 3,8 weeks. Distribution of inflammation was lumbar in 66 (94%) and thoracic in 4 (6%) patients. Thirtyfour patients (49%) had isolated spondylodiscitis (SD). Epidural abscess (ED) was found in 26 patients (37%). Ten patients (14%) showed a combination of SD and ED. SD or ED were predominantly found after previous surgery at the same or contiguous level 38 (54%). Nine patients (13%) suffered from ED or SD after previous lumbar epidural steroid injections (LESI). Spontaneous idiopathic inflammation was found only in 13 cases (19%). Standardized follow-up (FU) protocol was scheduled at 3, 12, and 24 month. FU rate was 60%. Healing of the inflammation was the rule. In our study cumulative EQ-5D increased from 0.47 to 0,80. ODI decreased from 41.1 to 24.3 and VAS concerning back pain decreased from 58.4 to 22.6 VAS according sciatica decreased from 46.8 to 20.5. Due to an increasing number of spine surgeries and spinal interventions as well as the increasing age and morbidity of patients, spinal surgeons have to deal more often with the diagnosis pyogenic spondylodiscitis. Standardized conservative or radical surgical treatment strategies in order to achieve good results according to patients life quality are gaining more importance

Introduction. Greater trochanteric pain syndrome (GTPS) is a common and disabling condition characterised by pain and tenderness at or around the trochanteric area. Extracorporeal shockwave therapy (ESWT) has been described as a method of treatment. The National Institute for Clinical Excellence (NICE, UK) guidance suggests a possible benefit but with limited evidence. Materials and Methods. We retrospectively identified 71 consecutive patients who underwent ESWT for refractory GTPS over a period of 16 months. The diagnosis was made clinically. ESWT was offered to patients with refractory symptoms despite conservative treatment. Telephone interviews were used to collect data including pain scores (0–10), change in symptoms, discomfort of the procedure, and complications. Results. Fifty-nine patients (83%) were followed up. The mean time to follow up was 8 months (3 to 19). The mean age was 59 (29 to 88) with 86% females. Two-thirds had improvement in their symptoms with a significant drop of 6 points in their pain score (p<0.05); however, symptoms recurred in 60% at a mean of 3.7 months. Most patients (60%) had mild or no discomfort from the treatment. Two patients (3.3%) could not tolerate the treatment. One complication was reported; an exacerbation of sciatica symptoms which settled spontaneously. Conclusion. This study shows an improvement in the symptoms of 67% of patients with refractory GTPS, for up to 15 months, but with frequent relapsed. Further research is required to confirm whether MRI may be useful in selecting patients for ESWT

Background. The relationship between obesity and cauda equina syndrome (CES) has not been previously evaluated or defined. Aim. Purpose of this study was to examine the presentation, timing of surgery, peri-operative complications and outcome of Cauda Equina Syndrome in relation to Body Mass Index. Methods. A single centre retrospective analysis was performed on 40 patients admitted with cauda equina syndrome. Data was collected regarding patient demographics, body mass index (BMI), co-morbidities, onset & mode of presentation and speed of functional recovery following surgery. Results. There were 18 males and 22 females with an overall average age of 38.9 years. The average height was 168.7 cm, and the average weight was 89.3 kg, giving an average BMI of 30.6 Kg/m2. 80% of patients were considered overweight (BMI 25–29.5) or obese (BMI >30). The average duration of back or leg pain prior to presentation was 4.2 years for the obese group and 1.3 years for the non-obese group. Bilateral sciatica, urinary incontinence and dense peri-anal numbness were the predominant presenting features in the obese group. Onset of symptoms was slow and gradually evolving in the obese group compared to the fast onset in the obese group. In the non-obese group, 71% underwent surgery within 24 hrs as opposed to 31% in the obese group. Average follow-up was 6months (6 weeks to 14 months). We observed that higher the BMI more slower the recovery with residual neurology and sphincter dysfunction. Patients in ideal group had prompt early symptomatic recovery with no residual neurology and full bladder recovery. There was correlation between increasing BMI and increased rate of surgical complications. Conclusion. This is the first study exploring the impact of body mass index on CES presentation and outcome. Specific care in establishing an early diagnosis in obese individuals is imperative for timely intervention