Background

The national back pain pathway sets out the gold standard pathway for patients with back and radicular pain. To improve implementation we needed to understand current practice and identify divergences from the pathway.

Background

Previous research in people with musculoskeletal low back pain (MLBP) in primary care shows that a reliable and valid measure of consultation-based reassurance enables testing reassurance against patient' outcomes. Little is known about the role of reassurance in people with MLBP consulting spinal surgeons, especially in cases where surgeons recommend not to have surgery. There might be several reasons to exclude surgery as a treatment option, that range from positive messages about symptoms resolving to negative messages, suggesting that all reasonable avenue of treatment have been exhausted.

AIM to explore patient's experience of consultation-based reassurance in people with MLBP who have been recently advised not to have surgery.

Background:

Following lumbar spine surgery patients with a high BMI appear to have increased post-operative complications including surgical site infections (SSI), urinary complications, increased anaesthetic/operative time and a greater need for post-operative blood transfusion. There is no current evidence, however, analysing the effect of BMI on functional outcome.

Spondylodiscitis is an uncommon condition with an incidence of 1:100,000 to 1:250,000 in developed countries. Diagnosis and treatment can be delayed resulting in poor outcomes. A high index of suspicion is necessary considering the associated mortality, reported at 2–17%.

Establishing a diagnosis can be challenging as features are non-specific and onset may be insidious. While treatment is usually conservative, certain situations require surgery. All patients however require careful assessment and monitoring for complications that may require further intervention. A review of our practice in Wexham Park and Heatherwood Hospital NHS Trust from 2009 to 2013 produced a guideline suggesting the need for blood cultures, imaging with MRI and involvement of the infectious diseases and spinal teams. We re-audited (20 cases) to assess compliance with the guidelines, which were in place to reduce the delay in diagnosis.

Recurrent presentation, infections of unknown origin and deterioration after a short course of antibiotics were indicators for triggering imaging of the spine for discitis. Delays in diagnosis were more marked in bacterial cases rather than tuberculosis. It was impossible to predetermine patients that would require surgical intervention. Our compliance with the guideline had improved from 70 to over 90% and there were no relapses or mortality.

Background

Epidural steroid injections can provide temporary relief of symptoms in the treatment of lumbar spinal stenosis. Surgery is indicated when conservative measures fail. We hypothesise that patients who gain temporary relief of symptoms from the administration of epidural steroid injections are more likely to result in an improvement in symptoms following surgical intervention compared to patients who do not respond to injection therapy.

Purpose and background

Whether to order an MRI scan or not for patients with low back and leg pain (LBP). Resources are limited. Waiting for diagnostic imaging impacts time to treatment and may be critical to the “18 week target”. We have looked into devising a system in which we can ordered MRI scans for patients with LBP pre-clinical assessment based on questionnaire and accessing their referral letter.

Background and Aims

Transforaminal epidurals (TFEs) have been widely used as a treatment for lumbar radicular pain since its introduction by Krempen and Smith in 1974¹. Originally used as a diagnostic tool, it is now becoming increasingly recognised as a definitive treatment². This study investigates the use of TFEs by a single surgeon over 4 years. We hoped that the study would add to our understanding and the discussion of the actual benefit of therapeutic steroid and local anaesthetic injections by this route³.

A number of studies have looked at the incidence of cervical rib in various ethnic groups, but have a number of limitations. This is the first large scale study looking at the incidence in White British with direct comparison to the Asian population. A total of 1545 consecutive cervical spine radiographs performed for any reason were collected and reviewed. 5.9% of White British and 24.9% of Asian patients had evidence of cervical rib. This was statistically significant (p< 0.0001, χ2 test). Asians are 5 times more likely compared to White British to have cervical rib (OR=5.303, 95% CI=3.825–7.354). An analysis of male Vs female difference as well as incidence of the various subtypes of cervical rib will be presented. We reccomend that the results of this study should

be considered in the assessment of patients with symptoms of thoracic outlet syndrome,

Introduction Magnetic resonance imaging (MRI) is a valid investigation for the diagnosis of intervertebral disc disease, including infection, but it is expensive and difficult to access conveniently for research studies on live animals under anaesthesia. The aim of this study was to compare the MRI signal changes in spines from living and recently deceased sheep.

Methods MRI was conducted on the lumbar spines of six adult sheep from research studies investigating bacterial discitis, chemical discitis and disc degeneration resulting from annular incision. The sheep was anaesthetised and the lumbar spines were imaged with a Siemens Magneton Vision MRI (Numaris VB33G software) using T1 SGE, T1 FSE, STIR and T2 FSE sequences. The sheep were killed with an intravenous overdose of barbiturate and identical images were obtained commencing five minutes post mortem.

Results For each of the disease processes under consideration the MRI contrast relationships were maintained between all of the anatomical structures of interest. The post-mortem images provided improved clarity, particularly in the STIR and T2-weighted sequences, due to the absence of pulsation from the CSF and aorta, as well as the absence of respiratory artefact.

Discussion The MRI appearances of spinal tissues following death correlate well with those in the live animal confirming the validity of this method of investigation. This is particularly relevant for optimisation of a busy clinical resource for research purposes.