The study aim is to evaluate the efficacy of dynamic MRI scanning in identifying radiological causes of positional sciatica over a 5-year period. We describe the results of a prospective series of patients who completed open MRI scanning, indicated for lower back pain and positional sciatica. 40 open MRI scans were requested between March 2012 and March 2017. 31 patients were intolerant to conventional MRI Scanning due to either claustrophobia or the inability to lie flat. 9 patients were identified as having positional sciatica. All patients completed the Oswestry Disability Index as part of their clinical assessment. The MRI images and radiology report were reviewed to identify surgically relevant causes. Dynamic foraminal narrowing and a progressive disc protrusion were identified in 2 patients who presented with positional sciatica. 23% of patients who were scanned had positional sciatica. 5% of patients indicated for open MRI scanning demonstrated surgically relevant changes on dynamic MRI scanning. 22% of those with positional sciatica demonstrated surgically relevant pathology on dynamic scanning.Purposes of study and background
Summary of methods used and the results
We describe the results of a prospective case series to evaluate a technique of direct pars repair stabilised with a construct that consists of a pair of pedicle screws connected with a u-shaped modular link that passes beneath the spinous process. Tightening the link to the screws compresses the bone grafted pars defect providing rigid intrasegmental fixation. 20 patients aged between 9 and 21 years with a pars defect at L5 confirmed on computed tomography (CT) were included. The average age of the patients was 13.9 years. The eligible patient had Grade I or less spondylolisthesis and no evidence of intervertebral degeneration on MRI. The average duration of follow-up was 4 years. Clinical assessments for all patients was via the Oswestry disability index (ODI) and visual analogue scores (VAS). At the latest follow-up, 18 of the 20 patients had excellent clinical outcomes with a significant (p<0.001) improvement in their ODI and VAS scores with a mean post-operative ODI score of 8%. Fusion of the pars defect as assessed by CT showed fusion rates of 80%. There were no hardware complications. The strength of the construct obviates the need for post-operative immobilisation.
To compare the complication profile of a muscle splitting approach to the anterior cervical spine with previously described approaches. The authors describe and compare the complications of an approach that exposes the anterior cervical spine by directly splitting the strap muscles in the midline with blunt dissection thereby potentially reducing iatrogenic complications. A retrospective review of 62 operations to the anterior cervical spine, between 2002 and 2009. Indications: Fusion and arthroplasty procedures for brachalgia, axial neck pain and trauma. The postoperative complications. The complication rate was favourable compared to previously described approaches. The muscle splitting approach to the anterior cervical spine has a low complication rate compared to previously described approaches, and allows the cervical spine to be approached with blunt dissection thereby potentially minimising iatrogenic approach related complications.
