Coccygectomy, surgical excision of the coccyx, may be used to treat coccydynia, a chronic and disabling condition of the lowest part of the spine. It is a controversial and infrequently performed operation that many surgeons are reluctant to perform due to the risks of rectal perforation and infection. The criteria for patient selection for coccygectomy remain ill-defined. We present a single surgeon case series of 17 patients who underwent coccygectomy for chronic coccydynia.

This was a retrospective observarional case series analysis. Case notes of 17 patients who underwent coccygectomy from 1999 -2009 were obtained and analysed. We then carried out telephone survey for which only 15 patients were contactable. We used the Milton Keynes Orthopaedic Patient Satisfaction survey and the modified Oswestry low back pain disability questionnaire.

All patients had a two to three year history of coccydynia; 15 following trauma, one following a caudal injection and one following birth delivery. All patients had received between one and five lignocaine/methylprednisolone injections prior to coccygectomy, with documented initial symptom relief. All 17 patients had documented hypermobile sacro-coccygeal joints. Post-operative symptom relief varied between 60% and 100%, with all patients reporting that they would have their surgery again. Complications included three post-operative wound infections. There were no cases of rectal perforation. Coccygectomy for intractable coccydynia is sometimes the only option available. With good patient selection, including identification of a hypermobile joint with initial symptom relief following local injection, coccygectomy is a successful and safe treatment.

To determine presenting features, treatment modalities and associated outcome following treatment of spinal dural arteriovenous fistulas in a tertiary centre.

Retrospective cohort study of patients with SDAVF assessed at a single tertiary referral centre, between 1999 and 2009. Medical records were used to identify intervention type, pre- and post-intervention Aminoff-Logue disability score (ALDS), recurrence rate, follow-up time and discharge status. Statistical analysis was performed using Wilcoxon signed rank.

26 patients were identified with 23 receiving intervention. Two were unavailable for follow up. Endovascular embolization was performed successfully in 13 patients, recurrence occurred in 6 of these, 3 of which were subsequently treated surgically. Surgery was the initial treatment for 10 patients due to either unsuccessful embolization attempt or proximity of the fistula to spinal artery feeders; only 1 of these recurred. ALDS-gait reduced (improved) by a mean of 0.33 points following intervention but this was not statistically significant (P=0.0645). There was negligible change in micturition and bowel ALDS. Improvement in ALDS was greater in patients treated with surgery first and also in patients whose fistula did not recur. Mean follow-up was 38 months with 56% of working age patients returning to work.

Both embolisation and surgery achieved the primary aim of reducing disease progression, leading to an improved ALDS. Outcome was superior if initially treated surgically and recurrence occurred more frequently in patients treated endovascularly. The small number of patients in our cohort emphasise the need for further studies into this group of patients.

Introduction and Aims: Improved survival has motivated aggressive surgery with musculoskeletal tumors. Pelvic resection is challenging because of the constraints of adjacent vital anatomy, and the considerable impact on limb and visceral function. The aims of this study was to assess the functional, oncologic and surgical outcomes following resections of the bony pelvis.

Method: Between 1996 and 2003, 49 patients underwent tumor resections of the pelvic ring. The mean age was 43 (range 15–72) years. There were 44 primary (36 bone, nine soft tissue) and five secondary tumors. Of the bone tumors, there were six osteosarcomas, five Ewings sarcomas, 12 chondrosarcomas and 13 others. Of the soft tissue tumors, nine were of neural origin. Tumor locations included the ilium, periacetabulum, pubic bones, sacrum or combinations of these. Neoadjuvant chemotherapy (seven patients) and pre-operative radiotherapy (eight patients) were also used. Function was assessed using the American Musculoskeletal Tumor Society Functional scoring system. No patient had metastases at presentation.

Results: Surgery – There were 40 limb sparing resections and nine hindquarter amputations. The surgical margins were intralesional (four), marginal (12), wide (28) and radical (five). Of the limb sparing surgery, prosthetic reconstructions were used in nine patients, biologic reconstructions in seven patients a combination of biologic and prosthetic reconstructions in three cases and no reconstructions in the others. The mean operating time was five (range 1.5–10) hours. The mean intra-operative blood loss was 10 (range 2–26) units. The average length of stay was 22 (range 2–110) days. Fifty percent of patients developed acute complications. Survival – There was one intra-operative death. There were nine local recurrences and 16 metastases. Death from disease occurred at a mean time of 13 (range 1–51) months. Mean follow-up was 28 (range 1–90) months. Functional assessment – Hind quarter amputation and periacetabular resections had the worse functional outcome. These accounted for almost 40% of all cases. Surprisingly, patients with periacetabular resections had the best score for emotional acceptance.

Conclusion: Pelvic resections are complex, demanding and accompanied by a high complication rate. Surgery significantly affects functional outcome. Disease control is similar to limb tumors and medium to long-term survival is possible. Emotional acceptance of surgery in survivors was surprisingly high. Major pelvic resection for malignancy appears justifiable.

Introduction The aim of this study was to assess the accuracy of CT-guided core needle biopsy of musculo-skeletal tumours.

Methods This is a retrospective study on a series of 127 patients with a musculoskeletal tumours. The biopsies were performed over a four year period from 1998 to 2001. The accuracy of the CT-guided core needle biopsy was determined by comparing the histology of the biopsy with the final histology of the specimen obtained at open biopsy or surgical resection of the tumour. The effective accuracy was determined by the accuracy of the biopsy to diagnose benign versus malignant.

Results CT-guided core needle biopsy in this series has an overall accuracy of 80%. The effective accuracy as determined by a malignant versus benign lesion was 89%. There were 86 malignant tumours with a biopsy accuracy of 81% and there were 41 benign tumours with a biopsy accuracy of 78%. The positive predictive value (PPV) of a malignant tumour is 100% and the PPV of benign tumour 94.9%. The most common site of biopsy was from the femur and thigh, together accounting for 39.4% of the tumours. The most common tumours in this series were liposarcoma (n=12), osteosarcoma (n=11) and giant cell tumour (n=11). There were no reported complications arising from the biopsy.

Conclusions CT-guided core needle biopsy is a safe and effective procedure that is important in the diagnosis and management of musculoskeletal tumours.