Background

Various studies have highlighted issues regarding the prevalence of back pain due to lead apron use. The health and safety executive guidelines on personal protection equipment state that an employee should be able to carry the weight of a lead apron without injury (HSE, 2017). It has been suggested that wearing a 15 pound lead apron can place pressures of up to 300 pounds per square inch of the intervertebral discs (Khalil, 1993), ‘interventionalist's disc disease’ has been identified as a confirmed entity (Ross et al. 1997).

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.

Compare the prevalence of psychological distress in claustrophobic patients compared with a non-affected group, together with determination of presenting disability and overall intervention rates.

Retrospective case notes review.

33 patients (13 males) all requiring MRI scan under sedation for claustrophobia (Group 1) were compared with an age and sex matched cohort that had MRI without sedation (Group 2). Both groups were drawn from the same chronic back clinic. Average age in both groups was 54 years (range 27-79 years). Both groups had standard conservative therapy, together with psychometric evaluation.

Primary: Zung Depression Index (ZDI), Modified Somatic Perception Questionnaire (MSPQ). Secondary: Oswestry Disability Index (ODI), intervention rates (surgery, injections and physiotherapy sessions)

Comparison of means -

22 patients (66.7%) in Group 1 were discharged after their MRI with no intervention compared to 7 patients (21.2%) in Group 2.

Claustrophobic patients with back pain showed higher levels of depression than non-claustrophobic patients, with a greater prevalence of psychological distress. Disability however was the same. The majority of claustrophobic patients had no intervention, with a lower rate than their non-claustrophobic peers. Claustrophobia is a proxy for psychological distress and should be considered in the overall evaluation of chronic back patients.

8 patients with cervical myelopathy treated by French-door laminoplasty and internal fixation. A novel technique of fixation is employed to provide immediate stability, pain relief and rapid mobilisation.

To report the clinical and radiological outcomes of this new fixation device for French–door laminoplasty with minimum follow-up of 30 months.

Hardware assisted laminoplasty has the potential advantage of instant stability and prevention of recurring stenosis. The use of titanium mini-plates has been described in open-door laminoplasty and now we describe this technique in French–door laminoplasty.

8 patients with cervical myelopathy secondary to congenital stenosis (2) and multi-level spondylotic myelopathy (6) underwent 2-4 level French–door laminoplasty and mini-plate fixation. The average follow-up was 46.5 months. Autogenous iliac crest bone graft was interposed between the sagittally split spinous processes and 16-18 holed titanium mini-plates were contoured into a trapezoidal shape and secured to the posterior elements with screws. Patients then mobilised without external support.

The mean follow-up was 46.5 months. The mean improvement in NDI at final follow-up was 35% and mean improvement in VAS was 4 points. JOA score improved from a mean of 10 to a mean of 14.8 post-operatively. All patients had achieved a significant neurological improvement and pain relief. There were no post-operative hardware related complications, pseudarthrosis or neurological deterioration.

French-door laminoplasty is an excellent alternative to laminectomy for treatment of young patients with cervical myelopathy. The use of titanium mini-plates not only provides instant stability and pain relief but also seems to minimize the risk of C5 nerve root palsy. Internal fixation appears to provide instant stability, early mobilisation and therefore reduces hospital stay and associated costs.