Introduction: Duplex ultrasound has recently been used to demonstrate inflammatory hyperaemia in arteries supplying inflamed joints in RA, bursitis, and tendonitis. The technique has yet to be applied to examine blood flow in lumbar arteries in LBP patients, though we have previously shown its feasibility in healthy subjects. Our aim was to determine if there are differences in the flow characteristics of lumbar arteries in patients with LBP that may be reflective of pathology.

Materials and Methods: Sixty four patients with LBP (21–82 years) and 30 volunteers with no history of LBP (19–82 years) were studied. Sacral and lumbar arteries at L5 to L1 were identified and hemodynamic data was obtained using Duplex ultrasound. Angle corrected measurements of blood flow peak systolic velocity (PSV) were obtained at all lumbar levels and the aorta.

Results: Mean lumbar artery PSV was normalized with mean aorta PSV for patient and control groups. Reference range (mean ± 1.96SD) for normal lumbar artery PSV was defined from the control data and the proportion of patients with abnormally high PSV determined.

Discussion: Blood flow velocity in lumbar arteries of LBP patients is significantly higher compared with asymptomatic controls (p< 0.01). Approximately 40% of the LBP group have abnormally high lumbar artery flow velocity and the proportion of abnormal values increases at lower levels. Abnormally high velocity flow suggests the presence of an inflammatory component in the lumbar spinal structures. This technique has important applications in improving diagnostic specificity and assessing outcome of treatment in patients with LBP.

Biopsy is a key step in the diagnosis of bone and soft tissue tumours. An inadequately performed biopsy may fail to allow proper diagnosis. An improperly planned biopsy may jeopardise plans for limb salvage surgery.

Aims: To analyse the effectiveness of core-needle biopsy for evaluation of suspected primary musculoskeletal neoplasms.

Methods: Core-needle biopsy was performed at our institution in 130 consecutive patients suspected of having a mesenchymal neoplasm. Details of the biopsy and any additional procedures were recorded including size of sample, method of localisation and any complications. Clinical and histological features of the neoplasm and previous radiological or histological diagnosis were compared. Core-needle biopsy results were correlated with results from specimens subsequently obtained at definitive surgery.

Results: 130 consecutive core biopsies were performed for evaluation of suspected primary musculoskeletal neoplasms. All patients tolerated the procedure well and there were no significant complications. A definitive diagnosis was obtained from a single core biopsy in 107 (82%) patients; an additional biopsy was necessary in 24 (18%) following equivocal histology. Twenty-three (96%) of these repeat biopsies were an open procedure. In 98% of patients, core-needle biopsy results were concordant with results from specimens subsequently obtained at surgery with respect to tumour histological features and grade. The accuracy and rate of performance of open biopsy for soft tissue lesions were not significantly different from those for bone lesions.

Conclusions: Obtaining tissue safely, for diagnosis of bone and soft tissue tumours is the goal of all biopsies The biopsy, however, must be well planned so as to avoid creating inadvertent tumour spread, and take into consideration any subsequent approaches for limb-sparing surgery.