Background: The prevalence and incidence of low back pain in general society is high. Workers whose job involves walking long distances have even a higher tendency to suffer from low back pain.

Purpose: Our goal was to examine the effect of insoles on low back pain among workers whose job involves long-distance walking.

Methods: In this double blind prospective study we examined the effectiveness of insoles constructed in a computerized method to placebo insoles in 58 employees whose work entailed extensive walking and who suffered from low back pain. The evaluation was performed by the MILLION questionnaire.

Results: 81% of the employees preferred the real insoles in comparison to 19% of the users of the placebo insoles (p < 0.05). A substantial improvement in the LBP after the use of the true insoles was noted.. The average pain intensity before the use of the insoles was 5.46. However, after the use of the real insoles and the placebo insoles the average pain intensity decreased to 3.96 and 5.11 respectively. The difference of the average pain intensity at the start of the study and after the use of the real insoles was significant: −1.49 (p=0.0001), whereas this difference after the use of the placebo insoles was not significant: −0.31 (p=0.1189). A level 5 pain and above was reported by 77% of the subjects at the start of the study. After the use of the real insoles 37.9% of the subjects reported a similar degree of pain severity, and 50% of the subjects did so after the use of the placebo (p< 0.05).

Conclusions: LBP decreased significantly after the use of real insoles compared to placebo ones.

Purpose: The elderly population is increasing in the modern world. Societies in general and medical personnel are facing new ethical and medical dilemmas when treating extremely old patients. Elderly patients have osteoporotic bone and hence a high incidence of fractures. Evaluating this unique group of patients who have hip fractures is our goal.

Materials and Methods: A retrospective analysis of all patients who had hip fractures between January 1990 and December 2001 and were beyond 100 years old was handled.

Data was collected from the medical files (hospitalization and out-patient charts) for age, sex, type of fracture, type of treatment, background disease, rehabilitation and time until death. The latter was confirmed by data from ministry of home office.

Results: 23 patients (17 females and 6 males) were found. Ages ranged from 100 and 107 (mean: 101.78). They had 4 subcapital and 19 per-subtrochanteric fractures. The patients had between 1–5 major background diseases. 4 patients were treated conservatively (1 due to major pneumonia and 3 refused the operative procedure). All these patients died at the same month of admission. Among the 19 patients who underwent operation, 12 patients have died and lived between 0–34 months (mean: 7.43) post-operatively, and 7 are still alive for 4–75 months (mean: 34.43) post-operatively. No differences between the operative and conservative groups in terms of major background disease were found.

Conclusions: Most of hip fractures in the extreme old age are per-subtrochanteric. Operative treatment yielded better results and should be the treatment of choice.

Objective: To determine the late (2–5 years) clinical results of surgery for herniated lumbar disc (HLD) as related to duration of preoperative symptoms and type of herniation.

Methods: The study was limited to 63 adult Moslem Arab residents of the hospital’s catchment area. All subjects had been scored for pre and postoperative leg pain and for related disability using a 0–11 visual analog scale and a functional grading system (Spangfort’s), respectively. Relationships between duration of preoperative symptoms and extent of disc herniation with the above scores were statistically analyzed.

Results: The mean overall score for leg pain decreased from 7.2 ± 2.0 (preoperatively) to 3.4 ± 2.4, a mean reduction (ΔVAS) of 3.1 ± 2.7, a 43.3% change (P< 0.001). Patients operated upon within 4 weeks after onset of symptoms attained the highest degree of leg pain relief (ΔVAS 4.3 ± 2.6), those operated within 4–12 weeks reported the least relief of leg pain (ΔVAS 1.7 ± 2.8). Paradoxically, patients who underwent surgery after 12 weeks received better results than the 4 – 12 week group (ΔVAS 3.0 ± 1.3). Patients with non-contained herniation reported a more intense preoperative leg pain than those defined as contained (VAS 8.3 vs. 6.5), were operated earlier (7.4 vs. 15.8 weeks), and their functional outcome was graded as better (Good/Fair in 96.4% vs. 74.3%).

Conclusions: Patients with incapacitating radicular pain, not responding to conservative treatments, are best operated upon within 6 weeks of onset. Surgery for non-contained herniation achieves a higher long-term success rate, probably since severe pain hastens surgical procedure, thereby preventing irreversible root damage.

Purpose of the study: To evaluate the efficacy and safety of a novel intramedullary, expandable and self-locking system for stabilization of proximal femoral fractures.

Patients and methods: Since October 2001, Fixion ® PF Nails have been implanted in 112 patients (84f / 28m) with mean age of 76.4 years (40–97). Ninety patients were operated for intertrochanteric fractures, and 22 for subtrochanteric fractures. The system consists of a diaphyseal nail and a femoral head peg. The nail is an expandable tube that, once inserted (unreamed) into the medullary canal, expands by 60%, using saline solution under controlled pressure. The expansion causes abutment of the nail longitudinal bars to the inner surface of the canal, resulting in excellent hold. The hip peg includes an expandable distal end, which, once expanded, condenses the travecular bone and enhances the femoral head grip and rotational stability.

Results: Average operative time was 62; minutes (25–90) and average fluoroscopy exposure 1.44 minutes (0.46–4.26). Perioperative blood loss was negligible. Optimal alignment was restored in all cases. No significant operative problems or complications were reported. Union was demonstrated in all cases within 12 weeks, except for two cases of severe osteoporosis, in which delayed cut-out of the implant was reported.

Conclusions: This minimally invasive procedure, requiring no reaming or use of interlocking screws, is user-friendly, safe, reduces the operative and fluoroscopy time, eliminates the risk of postoperative femoral shaft fracture and provides optimal ultimate outcome.

Study Design: We describe innovative minimally invasive Israeli made Expandable Spinal Fusion System for lumbar spinal fusion, in patients with all caused of mechanical back pain: Degenerative Disc Disease (DDD) at one or two levels from L2–S1, up to Grade l spondylolysthesis. The purpose of the study was to provide a preliminary evaluation of the safety and efficacy of the Expandable Spinal Fusion System in establishing vertebral stability and fusion, and in improving the quality of life of the patients.

The relatively large diameter of currently used cages dictates extensive manipulations, damaging structures that are crucial for spinal stability.

The Expandable Spinal Fusion System, is 5 mm in diameter in closed configuration, applied in a minimally invasive technique, through a 6mm entering opening by an open or percutaneous posterior procedures. Once in position, its dimensions are increased to a precut size in a controlled procedure. Thus, this system maintains the integrity of facet joints, with no or minimal laminectomy, and minimal damage to the surrounding tissues.

Methods: Data were collected in a series of 60 patients with DDD in levels L3–S1. The patients wee operated in the open posterior approach with or without Pedicle Screws and percutaneous posterolateral. Both end-plates faces were treated by special curettes and partially removed. Posterior iliac bone graft was used and 2 tubes device were introduced to the inter-somatic space under direct vision controlled by X-rays C-Arm intensifying magnification.

Data: The implantation approach was posterior in 52 patients, anterior in 2 and percutaneous in 6 patients. Maximal follow up period is 12 months. Patients follow up was completed according to investigational protocol mandate follow up visit at 1.5, 3, 6, 12 months postoperatively. The main at the time of the surgery was 52 years old. 57 underwent surgery at one level as follows: 3 at L3-L4, 32 at L4-L5, and 21 at L5-S1, and 3 underwent surgery at two levels.

Patient questionnaire pain and quality of life was evaluated using the Oswestry questionnaire and VAS measurement. The patient fill those pre-operatively and at each follow up visit.

Results: Although follow up period is short according to preliminary data, the Expandable Spinal Fusion System has proved to be safe, effective, as well as easy to handle for treating all cases of mechanical back pain: DDD. There was no neurological injury, no infection, no death and no worsening of clinical symptoms. There was no breakage or migration of the implant at the last follow-up. Flexion-Extension X-ray show good stability. VAS score for pain dropped from 8 pre op to 2.6 in average 3 months post-op.