Back ground:

The aim of this study is to evaluate the long-term outcome after posterior spinal stabilization surgery for the management of de novo non-tuberculous bacterial spinal infection.

Back ground:

Previous studies have stated that presence of concomitant back pain has a negative effect on the outcome of lumbar decompression/microdiscectomy but none have actually defined what level of back pain should be considered as significant. This is a study of consecutive patients who underwent a primary single level lumbar micro decompression /microdiscectomy performed by thirty nine surgeons at a single tertiary spinal centre between August 2011 and December 2014. The aim was to determine the differential effect of the intensity of back pain and leg pain as a predictor of outcome.

Study Design: A prospective evaluation of 40 consecutive patients with sciatica who had ‘Normal’ MRI scans, were further investigated with Nerve Root Injections (NRI), and subsequent surgery in those who had relief of symptoms.

Objectives: To evaluate the diagnostic value of NRI’s in the presence of normal MRI scans and to assess the aetiology of the sciatica.

Summary of Background Data: Since the advent of MRI scans the use of NRI’s has been in decline as a diagnostic tool. There has been no study in their usefulness when the MRI has been reported as showing no evidence of nerve root compression, and furthermore what the surgical findings were in the patients who went on to exploration.

Methods: 40 Patients with sciatica, of minimal duration of one year, in whom the MRI scan had been reported as showing no evidence of nerve root compression by an independent observer, had diagnostic NRI’s performed. Those patients that had reproduction of and subsequent temporary relief of their sciatica had surgery.

Outcome Measures: Walking distance, Analgesic Requirements, Sleep disturbance and VAS.

Results: Of the 40 patients, 25 had no benefit, 4 patients had permanent relief and 11 had temporary relief. These 11 patients underwent surgery. All patients undergoing surgery were L5 nerve root explorations. In 9 cases the compression was by the ligamentum flavum and in 2 at the foramen. Of the eleven cases operated on 9 had complete relief of symptoms and 2 were unchanged.

Conclusions: MRI scans do not show a cause for sciatica in all patients as it is not a dynamic test. In the presence of a normal MRI scan, NRI’s should be performed.

Objective: To document the incidence of adjacent superior segment facet joint violation following transpedicular instrumentation in the lumbar spine as it has been postulated that this can lead to long term deterioration There has been no study so far determining this incidence.

Design: Patients undergoing lumbar fusion were prospectively evaluated with a CT scan and plain radiographs six months following surgery. These were blindly and independantly evaluated by a consultant radiologist and a research fellow.

Subjects: 106 patients (212 top level facet screws) between 1996 and 1999 were evaluated. All patients had their screws and instrumentation inserted through a Wiltse muscle splitting approach and a lateral entry point in the pedicle so as to reduce the risk of facetal impingement. ¹

Outcome Measures: Kappa co-efficient and chi-squared analysis.

Results: The Kappa co-efficient for the CT scan and plain radiographs were 0.88 and 0.39 respectively. On the CT scan both observers noted facet joint impingement in just over 20% of the screws and just over 30% of the patients. The impingement was independent of the level and diagnosis (p> 0.05) and it occurred with uniform incidence in each of the year.

Conclusion: This study raises the theoretical possibility of long term deterioration in the clinical results following the use of transpedicular instrumentaion.

Objectives: To determine if high quality, thin slice (1–3)mm CT scan images would allow proper evaluation of interbody fusion through titanium cages in view of the fact that there are no universally accepted radiological criteria. ¹

Design: Patients undergoing interbody lumbar fusion were prospectively evaluated with a CT scan and plain radiographs six months following surgery. These were blindly and independently evaluated by a consultant radiologist and a research fellow. They were assessed for bridging bony trabeculation both through and surrounding the cages as well as for changes at the cage endplate interface.

Subjects: Fifty-three patients (156 cages) undergoing posterior lumbar interbody fusion using titanium inter-body cages were evaluated. Posterior elements were used to pack the cages and no graft was packed outside the cages.

Outcome Measures: Kappa co-efficient and chi-squared analysis.

Results: On the CT scan both observers noted bridging trabeculation in 95%of the cages-Kappa 0.85, while on radiographs they were present in only 4%-Kappa 0.74. Both observers also identified bridging trabeculation surrounding the cages on the CT scans in 90%-Kappa 0.82, while on the radiographs this was 8%-Kappa 0.86. Radiographs also did not identify all the loose cages.

Conclusions: High quality CT scan images can demonstrate bridging bony trabeculation following the use of titanium interbody cages. It also demonstrated consistent bone growth outside the cages inspite of not using any bone graft.