Aims. The aim of the study was to determine if there was a direct correlation between the pain and disability experienced by patients and size of their disc prolapse, measured by the disc’s cross-sectional area on T2 axial MRI scans. Methods. Patients were asked to prospectively complete visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores on the day of their MRI scan. All patients with primary disc herniation were included. Exclusion criteria included recurrent disc herniation, cauda equina syndrome, or any other associated spinal pathology. T2 weighted MRI scans were reviewed on picture archiving and communications software. The T2 axial image showing the disc protrusion with the largest cross sectional area was used for measurements. The area of the disc and canal were measured at this level. The size of the disc was measured as a percentage of the cross-sectional area of the spinal canal on the chosen image. The VAS leg pain and ODI scores were each correlated with the size of the disc using the Pearson correlation coefficient (PCC). Intraobserver reliability for MRI measurement was assessed using the interclass correlation coefficient (ICC). We assessed if the position of the disc prolapse (central, lateral recess, or foraminal) altered the symptoms described by the patient. The VAS and ODI scores from central and lateral recess disc prolapses were compared. Results. A total of 56 patients (mean age 41.1 years (22.8 to 70.3)) were included. A high degree of intraobserver reliability was observed for MRI measurement: single measure ICC was 0.99 (95% confidence interval (CI) from 0.97 to 0.99 (p < 0.001)). The PCC comparing VAS leg scores with canal occupancy for herniated disc was 0.056. The PCC comparing ODI for herniated disc was 0.070. We found 13 disc prolapses centrally and 43 lateral recess prolapses. There were no foraminal prolapses in this group. The position of the prolapse was not found to be related to the mean VAS score or ODI experienced by the patients (VAS, p = 0.251; ODI, p = 0.093). Conclusion. The results of the statistical analysis show that there is no direct correlation between the size or position of the disc prolapse and a patient’s symptoms. The symptoms experienced by patients should be the primary concern in deciding to perform discectomy. Cite this article: Bone Joint J 2022;104-B(6):715–720

Background. Partial facetectomies with pedicle screw instrumentation is widespread and a well described technique for achieving posterior correction of scoliosis. Newton et al. first described the use of the UBS in the posterior correction of AIS in 2014. The aim of this study was to compare the effectiveness of the UBSPO in achieving posterior correction in Type1 AIS as compared to the traditional partial facetectomies. Aim of this study was to assess the effectiveness of USBPO in achieving posterior correction in Type 1 AIS as compared to partial facetectomies. Methods. A retrospective review of 40 patients with type 1 AIS who had undergone a posterior correction of scoliosis between 2010 and 2016 was performed. Group A (n=20) consisted of consecutive patients that had partial facetectomies while Group B (n=20) consisted of consecutive patients having UBSPO. Both groups were matched for demographic parameters. Pre and post-operative radiographic parameters and operative data in both groups were compared. The Mann-Whitney U test was used for statistical analysis. Results. There was no significant difference between the two groups in terms of age, sex, magnitude of curves, apical rotation and flexibility on the preop imaging. There was a significant difference between the mean postop Cobb angle (21.9° vs 9.8°, p<0.0005), correction (63.04% vs 84.3%, p<0.0005) and postop apical rotation (p = 0.008) in favour of the UBSPO group. At 2-year follow-up there was a statistically significant increase in the cobb angle in the facetectomy group (21.89° (immediate post op) Vs 24.64° P=0.033) and no such difference in the UBSPO group. There was no significant difference between surgical time (p = 0.536) and blood loss (p = 0.380). Conclusion. The use of the UBSPO for posterior release provides more effective correction in the coronal and axial planes than traditional partial facetectomies in type 1 AIS

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In this investigation, we administered oxidative stress to nucleus pulposus cells (NPCs), recognized DNA-damage-inducible transcript 4 (DDIT4) as a component in intervertebral disc degeneration (IVDD), and devised a hydrogel capable of conveying small interfering RNA (siRNA) to IVDD.

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People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from recommended non-surgical treatments. However, National Institute for Health and Care Excellence (NICE) 2016 guidelines recommended not offering spinal fusion surgery for adults with LBP, except as part of a randomized clinical trial. This survey aims to describe UK clinicians’ views about the suitability of patients for such a future trial, along with their views regarding equipoise for randomizing patients in a future clinical trial comparing lumbar spine fusion surgery to best conservative care (BCC; the FORENSIC-UK trial).

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This study aimed, through bioinformatics analysis and in vitro experiment validation, to identify the key extracellular proteins of intervertebral disc degeneration (IDD).

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The aim of this study was to determine whether early surgical treatment results in better neurological recovery 12 months after injury than late surgical treatment in patients with acute traumatic spinal cord injury (tSCI).

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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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Symptomatic spinal stenosis is a very common problem, and decompression surgery has been shown to be superior to nonoperative treatment in selected patient groups. However, performing an instrumented fusion in addition to decompression may avoid revision and improve outcomes. The aim of the SpInOuT feasibility study was to establish whether a definitive randomized controlled trial (RCT) that accounted for the spectrum of pathology contributing to spinal stenosis, including pelvic incidence-lumbar lordosis (PI-LL) mismatch and mobile spondylolisthesis, could be conducted.

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Scoliosis is a lateral curvature of the spine with associated rotation, often causing distress due to appearance. For some curves, there is good evidence to support the use of a spinal brace, worn for 20 to 24 hours a day to minimize the curve, making it as straight as possible during growth, preventing progression. Compliance can be poor due to appearance and comfort. A night-time brace, worn for eight to 12 hours, can achieve higher levels of curve correction while patients are supine, and could be preferable for patients, but evidence of efficacy is limited. This is the protocol for a randomized controlled trial of ‘full-time bracing’ versus ‘night-time bracing’ in adolescent idiopathic scoliosis (AIS).

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The aim of this study was to report the long-term prognosis of patients with multiple Langerhans cell histiocytosis (LCH) involving the spine, and to analyze the risk factors for progression-free survival (PFS).

Aims. The aim of this study was to investigate the impact of maturity status at the time of surgery on final spinal height in patients with an adolescent idiopathic scoliosis (AIS) using the spine-pelvic index (SPI). The SPI is a self-control ratio that is independent of age and maturity status. Patients and Methods. The study recruited 152 female patients with a Lenke 1 AIS. The additional inclusion criteria were a thoracic Cobb angle between 45° and 70°, Risser 0 to 1 or 3 to 4 at the time of surgery, and follow-up until 18 years of age or Risser stage 5. The patients were stratified into four groups: Risser 0 to 1 and selective fusion surgery (Group 1), Risser 0 to 1 and non-selective fusion (Group 2), Risser 3 to 4 and selective fusion surgery (Group 3), and Risser 3 to 4 and non-selective fusion (Group 4). The height of spine at follow-up (HOS. f. ) and height of pelvis at follow-up (HOP. f. ) were measured and the predicted HOS (pHOS) was calculated as 2.22 (SPI) × HOP. f. One-way analysis of variance (ANOVA) was performed for statistical analysis. Results. Of the 152 patients, there were 32 patients in Group 1, 27 patients in Group 2, 48 patients in Group 3, and 45 patients in Group 4. Significantly greater HOS. f. was observed in Group 3 compared with Group 1 (p = 0.03) and in Group 4 compared with Group 2 (p = 0.02), with similar HOP. f. (p = 0.75 and p = 0.83, respectively), suggesting that patients who undergo surgery at Risser grade of 0 to 1 have a shorter spinal height at follow-up than those who have surgery at Risser 4 to 5. HOS. f. was similar to pHOS in both Group 1 and Group 2 (p = 0.62 and p = 0.45, respectively), indicating that undergoing surgery at Risser 0 to 1 does not necessarily affect final spinal height. Conclusion. This study shows that fusion surgery at Risser 0 may result in growth restriction unlike fusion surgery at Risser 3 to 4. Despite such growth restriction, AIS patients could reach their predicted or ‘normal’ spinal height after surgery regardless of baseline maturity status due to the longer baseline spinal length in AIS patients and the remaining growth potential at the non-fusion levels. Cite this article: Bone Joint J 2018;100-B:1372–6

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Lumbar disc prolapse is a frequent indication for surgery. The few available long-term follow-up studies focus mainly on repeated surgery for recurrent disease. The aim of this study was to analyze all reasons for additional surgery for patients operated on for a primary lumbar disc prolapse.

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Vertebral body tethering (VBT) is a non-fusion technique to correct scoliosis. It allows correction of scoliosis through growth modulation (GM) by tethering the convex side to allow concave unrestricted growth similar to the hemiepiphysiodesis concept. The other modality is anterior scoliosis correction (ASC) where the tether is able to perform most of the correction immediately where limited growth is expected.

Objectives:. To establish the demand, referral pathways, utility and patient satisfaction of a physiotherapy led post operative spinal surgery review clinic. Methods:. From July 2014 to January 2015 a pilot physiotherapy led clinic was established. The following clinic data was collected: number of patients reviewed, surgical procedure, outcome of clinic assessment, numbers requiring further investigation, numbers requiring review in the consultant led clinic and adverse events. A patient satisfaction survey was also administered to all English speaking patients. Patients were asked to rate the ease of getting through to the service by phone, length of wait, time spent with the clinician, answers to questions, explanation of results, advice about exercise and return to activities, the technical skills of the clinician, their personal manner and their overall visit. Data was anonymised and inserted into an excel spreadsheet for analysis. Descriptive statistical analysis was undertaken. Results:. 28 patients were reviewed in the pilot clinic. 17 (61%) patients were reviewed and discharged. 11 (39%) patients required discussion with the consultant. The outcome was: Referral for further imaging: n=5 (18%), referral to other specialist: n=2 (6%), consultant led OPD clinic review n=4 (14%) and surgical review of wound n=1 (4%). 84% (n=21/25) of eligible patients completed a post operative satisfaction survey. 86% (n= 18/21) rated their overall visit as excellent. There were no adverse events reported. Conclusion:. The pilot clinic has informed the development of a permanent physiotherapy led post op clinic in the National Neurosurgical Spinal Service and demonstrates the value of interdisciplinary care in this population

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Non-coding microRNA (miRNA) in extracellular vesicles (EVs) derived from mesenchymal stem cells (MSCs) may promote neuronal repair after spinal cord injury (SCI). In this paper we report on the effects of MSC-EV-microRNA-381 (miR-381) in a rodent model of SCI.

Background. Recommendations in clinical practice guidelines for non-specific low back pain (NSLBP) are not necessarily translated into practice. Multiple research studies have investigated different strategies to implement best evidence into practice yet no synthesis of these studies is available. Objectives. To systematically review available studies to determine whether implementation efforts in this field have been successful; to identify which strategies have been most successful in changing healthcare practitioner behaviours and patient outcomes. Methods. A systematic review was undertaken, searching electronic databases, hand searching, writing to key authors and using prior knowledge of the field to identify papers. Included papers evaluated a strategy to implement best evidence about management of NSLBP into practice; measured key outcomes regarding change in practitioner behaviour/patient outcomes and subjected their data to statistical analysis. The Cochrane Effective Practice and Organisation of Care (EPOC) recommendations about data extraction and synthesis were followed. Study inclusion, data extraction and study risk of bias assessments were conducted independently. Results. Of 7654 potentially eligible citations, 17 papers reporting on 14 studies were included. Single/one-off implementation efforts were consistently unsuccessful. Increasing the frequency and duration of strategies led to greater success with those continuously ongoing over time the most successful. Risk of bias was highly variable with 7 of 17 papers rated at high risk. Conclusions. One-off implementation strategies may seem attractive but are largely unsuccessful in effecting meaningful change in practice. Increasing frequency and duration of strategies results in greater success and the most successful implementation strategies use consistently sustained interventions

Much debate exists over the value of exercise therapy for treating adolescent idiopathic scoliosis (AIS). This study aims to address the current evidence. An extensive search was carried out using the common medical databases, limiting results to clinical trials in English involving humans with defined outcome measures. 155 papers were identified and after applying strict inclusion criteria 12 papers remained for further analysis. These included 9 prospective cohort trials, 2 retrospective cohort trials and one case series. No randomised controlled trials were identified. Although all of the papers concluded an improvement in scoliotic curve after exercise therapy, not one of the papers had reliable methods or results to validate their conclusions. Identified shortcomings included, poor compliance with outpatient exercise regimes with no clear indication of who assessed for curve improvement, how it was assessed or what experience they had, nor was observer error for Cobb angle measurement taken into account. Additionally only a few of the studies had sound statistical analysis and no study could comment on whether the improvements seen were maintained after the exercise regime. Four previous systematic reviews have been performed finding favourable results for exercise therapy, but these were written by authors involved in the original research, adding significant reviewer bias. This systematic review has revealed only poor and low level evidence supporting the use of exercise therapy for treating AIS. Well designed controlled trials with randomisation are required to validate exercise therapy as an effective treatment option and as an appropriate use of NHS funds

Purpose. To determine if clinical outcomes are correlated with center of rotation (COR) in patients implanted with a viscoelastic total disc replacement (VTDR). Methods. Fifty patients with single-level, symptomatic lumbar DDD between L4 and S1 were enrolled in a clinical trial of a VTDR across three surgical centres. A comprehensive, independent review and statistical analysis of both clinical and radiographic outcomes was performed and analyzed for correlations. Data from preoperative through 2 years were available. The COR was calculated for the index levels and compared to data for an asymptomatic population. Each COR coordinate was classified as abnormal if outside of the 95% confidence interval for an asymptomatic population. Results. At most recent follow-up, 69% of the patients had achieved at least a 15 point Oswestry Disability Index (ODI) improvement. 76% of the patients achieved at least a 10 point improvement. At most recent follow-up, 78% of cases had a normal COR-X and 92% had a normal COR-Y. Results from three statistical tests show the association between COR-X and outcomes. 1) Based on latest available time point for each patient, the improvement in ODI score was significantly better for patients with a normal anterior-posterior (AP) coordinate of the COR (P=0.03). 2) Anterior COR corresponded with anterior placement of the device in the disc space, and patients were almost 7 times less likely to achieve at least a 15 point improvement in the ODI score if the COR was positioned too anteriorly. 3) This effect was also seen in the average AP coordinate of the COR for patients who achieved a 15 point ODI improvement. Conclusions. A viscoelastic TDR can restore a normal COR. This is the first study to show that restoration of a normal COR correlates with a significant and clinically relevant improvement in patient disability

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With recent progress in cancer treatment, the number of advanced-age patients with spinal metastases has been increasing. It is important to clarify the influence of advanced age on outcomes following surgery for spinal metastases, especially with a focus on subjective health state values.

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Whether a combined anteroposterior fusion or a posterior-only fusion is more effective in the management of patients with Scheuermann’s kyphosis remains controversial. The aim of this study was to compare the radiological and clinical outcomes of these surgical approaches, and to evaluate the postoperative complications with the hypothesis that proximal junctional kyphosis would be more common in one-stage posterior-only fusion.