Introduction

Luk (Luk et al. Spine vol 23(21) 2303-2307 1998) has shown that in posterior surgery, the correction achieved can be predicted by fulcrum bending films. The relevance to anterior correction has been disputed, as this commonly involves shortening the spine by the removal of intervertebral discs. The aim of the study was to see whether the pre-operative bending angle reflected the degree of correction achieved.

Purpose

1. To evaluate how radiological parameters change during the first 3 years following anterior endoscopic surgery. 2. To report complications encountered in this period.

Introduction

Following the publication of our original survey in 2000 (Eur. Sp. J. 11(6):515-8 2002) we have sought to re-evaluate the perceptions and attitudes towards spinal surgery of the current UK orthopaedic Specialist Registrars (SpRs), and to identify factors influencing an interest in spinal surgery. At that time 175 orthopaedic spinal surgeons in the UK needed to increase by 25% to satisfy parity with other European countries.

Introduction

This study investigates the effect of somatisation on results of lumbar surgery.

The recent NICE guidelines on management of osteoarthritis outline weight loss as first line treatment in degenerative joint disease in the obese. There is little data surrounding the effects of obesity on the outcomes in spinal surgical interventions. Intervertebral discectomy is one treatment for prolapse of a lumbar vertebral disc. We aim to investigate the effect of obesity on outcomes for discectomy.

Demographic details including age, sex, weight and BMI were recording with a pre-operative Oswestry Disability Index (ODI). The fat thickness was measured at L5/S1 using calibrated MRI scans. Outcome measures included complications, length of surgery and change in ODI at 1 year following surgery. Obesity was defined as a body mass index of over 30. The units Serial patients undergoing discectomy were recruited into the study. Patients with bony decompression, instrumentation, revision surgery or multilevel disease were excluded.

Fifty patients with a single level uncomplicated disc prolapse were entered into the study. Sixteen patients had a BMI over 30 and so were obese, whilst 34 had a BMI of less than 30. The mean pre-operative ODI was 46.5 in the obese group and 52 in the normal group this difference was not significant (p> 0.05). The mean post operative ODI was statistically improved in the high BMI group at 28 (18.5 point improvement) and 25.2 (29.1 point improvement) in the normal group. The ODI improvement was significantly better in the low BMI group (p=0.036). There was no significant difference in operative time (p=0.24). Only a single patient had a complication (dural leak), so no valid comparison could be made.

The outcomes of spinal surgery in the obese are mixed.

We found no increase in the complication rate or intra-operative time associated with an increased BMI. However, the improvement in ODI was significantly better in the normal BMI group.

Introduction: This study investigates the effect of somatisation on results of lumbar surgery.

Methods: Pre- and postoperative data of all primary discectomies and posterior lumbar decompressions was prospectively collected. Pain using the Visual Analogue Score (VAS) and disability using the Oswestry Disability Index (ODI) were measured. Psychological assessment used the Distress Risk Assessment Method (DRAM). Follow-up was at 1 year.

Results: There were a total of 320 patients (average age 49.7 years). Preoperatively there were 61 Somatising and 75 psychologically Normal patients. 47 of the pre-operative Somatisers were available for follow-up.

All pre-operative parameters were significantly higher compared with the Normal group (back pain VAS 6.3 and 3.8; leg pain VAS 7 and 4.7; ODI 61 and 34.4 respectively).

At 1 year follow-up, 23% of the somatising patients became psychologically Normal; 36% became At Risk; 11% became Distressed Depressed; and 30% remained Distressed Somatisers.

The postoperative VAS for back and leg pain of the 11 patients who had become psychologically Normal was 3.4 (pre-op 6.8) and 3.2 (pre-op 6.6) respectively. In the 14 patients who remained Distressed Somatisers the corresponding figures were 5.6 (pre-op 7.8) and 6.7 (pre-op 7.0).

The postoperative ODI of the 11 patients who had become psychologically Normal was 26.4 (pre-op 55.5). In the 14 patients who remained Distressed Somatisers the corresponding figures were 56.7 (pre-op 61.7).

These differences are statistically significant.

Discussion: Patients with features of somatisation are severely functionally impaired preoperatively. One year following lumbar spine surgery, 60%(28) had improved psychologically, 23%(11) were defined as psychologically normal. This was associated with a significant improvement in function and back and leg pain. The 14(30%) patients who did not improve psychologically and remained somatisers had a poor functional outcome. Our results demonstrate that psychological distress is not an absolute contraindication to lumbar spinal decompressive surgery.

Introduction: This study investigates the effect of soma-tisation on results of lumbar surgery.

Methods: Pre- and postoperative data of all primary discectomies and posterior lumbar decompressions was prospectively collected. Pain using the Visual Analogue Score (VAS) and disability using the Oswestry Disability Index (ODI) were measured. Psychological assessment used the Distress Risk Assessment Method (DRAM). Follow-up was at 1 year.

Results: There were a total of 320 patients (average age 49.7 years). Preoperatively there were 61 Somatising and 75 psychologically Normal patients. 47 of the pre-operative Somatisers were available for follow-up.

All pre-operative parameters were significantly higher compared with the Normal group (back pain VAS 6.3 and 3.8; leg pain VAS 7 and 4.7; ODI 61 and 34.4 respectively).

At 1 year follow-up, 23% of the somatising patients became psychologically Normal; 36% became At Risk; 11% became Distressed Depressed; and 30% remained Distressed Somatisers.

The postoperative VAS for back and leg pain of the 11 patients who had become psychologically Normal was 3.4 (pre-op 6.8) and 3.2 (pre-op 6.6) respectively. In the 14 patients who remained Distressed Somatisers the corresponding figures were 5.6 (pre-op 7.8) and 6.7 (pre-op 7.0).

The postoperative ODI of the 11 patients who had become psychologically Normal was 26.4 (pre-op 55.5).

In the 14 patients who remained Distressed Somatisers the corresponding figures were 56.7 (pre-op 61.7).

These differences are statistically significant.

Discussion: Patients with features of somatisation are severely functionally impaired preoperatively. One year following lumbar spine surgery, 60%(28) had improved psychologically, 23%(11) were defined as psychologically normal. This was associated with a significant improvement in function and back and leg pain. The 14(30%) patients who did not improve psychologically and remained somatisers had a poor functional outcome. Our results demonstrate that psychological distress is not an absolute contraindication to lumbar spinal decompressive surgery.

Introduction: Following the publication of our original survey in 2000 (Eur. Sp. J.11(6):515–8 2002) we have sought to re-evaluate the perceptions and attitudes towards spinal surgery of the current UK orthopaedic Specialist Registrars (SpR’s), and to identify factors influencing an interest in spinal surgery. At that time 175 orthopaedic spinal surgeons in the UK needed to increase by 25% to satisfy parity with other European countries.

Methods: A postal questionnaire was sent to all 950 SpR’s. The questionnaire sought to identify perceptions in spinal surgery, levels of current training and practice, and intentions to pursue a career in spinal surgery.

Results: As before, a 70% response rate has confirmed that 74% of trainees intend to avoid spinal surgery (69% in 2000). However 10% are committed to become a Specialist Spinal Surgeon (9% in 2000). Their perceptions were wide ranging but most concluded that the intellectual challenge and opportunities for research are widely recognised. However enthusiasm is dampened by poor perceptions of outcomes from surgery, negative somatization and depression associations, complications and the fear of litigation. In some areas there is inadequate exposure to spinal surgery during the first 4 years of training.

Conclusions: Spinal surgery remains a career choice for 10% of surgical trainees (up 1% since 2000). With a large SpR expansion (578 to 950 SpRs in the last 5 years) an average of 16 new spinal surgeons annually will be produced over the next six years. This has improved on the figure of 8.6 per year from 2000 and represents a 200% increase in numbers per year. These figures suggest that by 2011 and allowing for retirement, there should be enough spinal surgeons to meet the desired UK/Europe ratio.

Introduction: We conducted a retrospective study at our institution to see what effect, if any, the use of impacted morsellised bone allograft technique had on the incidence of early and late infection in revision hip arthroplasty where contemporary measures were taken.

Patients and Methods: This study included 120 patients.

Patients were 36 male and 84 females with the mean age at the time of revision surgery was 71.4 years (range 42 – 89 SD 9.7).

In all the patients their indication for revision surgery was aseptic loosening.

All the patients had impacted morsellised bone allograft as part of the reconstruction used with cemented prostheses.

Clinical and radiological assessments of all patients were conducted for average of four years follow up.

Results: At mean follow up period of 4 years the early infection rate was 0.8% and late infection rate was 0%.

Conclusion: In our study the use of morsellised bone allograft does not appear to have added risk effect on the incidence of early or late hip joint infection provided contemporary measures are taken.

Aim: This study is describes the clinical and radiological results of 28 hips with Paprosky Type 3 acetabular defects treated by impacted morsellised bone allograft technique and followed up for a mean period of 72 months. Method: The complete cohort of 27patients (28 hips) classiþed as severe acetabular deþciencies (Paprosky type 3) and got treated by impacted morsellised bone allograft technique was available for clinical and radiological review at mean follow up of 72 months (range 48 to 91 months). All the patients were assessed clinically according to the Harris hip-score. All radiographs were digitised using high resolution digitiser. Measurements of subsidence and migration were done using image analysis software. All the radiographs were examined for evidence of radiolucent lines in the three zones of DeLee and Charnley and graft incorporation was assessed from serial radiographs. Results: The results of revision surgery using this technique showed a clinical survival of 96.4% and radiological survival rate 92.85%. Conclusion: Our results have shown that the clinical and radiological results using impacted morsellised allograft technique have been extremely gratifying. The morphological changes seen in these grafts would indicate that the bone grafts utilised have not only incorporated but continue to function in a stable manner. The technique of impaction bone allograft using morsellised fresh frozen allograft appears to be a valuable biological option in revising cases with severe acetabular deþciencies with superior mid-term results.

Immobility has been used as an indication for conservative treatment of patients with fractures of the hip, although there is little in the literature to support this view. We conducted a prospective review of 3515 patients with hip fractures of whom 152 (4.3%) were immobile prior to the fracture. Nine patients were treated conservatively, the rest by operation. The mean age was 83 years (42 to 99); the mean length of hospital stay was 17.8 days; 19 patients (12.5%) died whilst still in hospital and 120 (79.0%) went back to their original residence. There were 38 post-operative complications.

At one year after injury, 73 patients were still alive. Of the survivors, 54 (74.0%) had none or minimal pain in the hip and 58 (79.5%) had the same residential status as before the fracture. Immobility in patients with hip fracture is uncommon and is not a valid reason for withholding surgical treatment.

Femoral Impaction allografting is now an established method in revision hip arthroplasty where there is a deficiency in bone stock. Most experience of this technique has been in conjunction with a cemented collarless, polished, tapered (CPT) stem. We conducted a retrospective study into the clinical and radiological results of 67 consecutive patients with an average of 62 months (36–108 months) follow-up. In all cases, Impaction bone grafting was performed using a transtrochanteric approach and cemented Charnley and Elite Plus stems.

In our series no femoral component has been revised. The overall subsidence was 2.2 mm. 57 hips (85%) showed subsidence of 4 mm or less. However two patients showed massive subsidence of greater than 10mm, both with associated osteolysis and radiolucent lines. In addition, one stem showed a progressive varus position and debonding of the cement-metal interface. Analysis of the bone allograft showed evidence of incorporation in 56 (84%) of patients. The Merle D’Aubigne-Postal clinical score increased from an average of 8.3 pre-operatively to 15.3 at the last review. 60 patients (89.5%) complained of no or slight pain.

There was a 10% re-operation rate due to complications. Three patients sustained periprosthetic fractures around the tip of the prosthesis, all successfully treated with a plate. Three patients suffered recurrent dislocation, two needed revision of the acetabula component. Two patients needed trochanteric wires removed for persistent pain.

Direct comparison of different prostheses is difficult due to many confounding variables. However the medium term results of our study are comparable to the results reported using the Exeter and CPT stems.