This prospective study was carried out to correlate findings of magnetic resonance imaging (MRI) and discography. Fifty-five consecutive patients with degenerative disc disease not responding to non-operative treatment were included in the study. There were 19 men and 36 women and the mean age was 45 years. Discography was carried out on 131 disc levels. The discograms were classified using modified Adams’s classification and pain recorded into three grades. MRI scans were graded using a new classification system based on parasagittal and axial images by two independent observers blinded to discography findings. There was good intraobserver (kappa 0. 74) and interobserver (kappa 0. 70) agreement for the classification system. There was a significant correlation in the morphology of discs as determined by discograms and MRI classification (p< 0. 001).

Each disc was graded on MRI scan as painful or painless on basis of defined criteria. Concordant discography pain was considered as the gold standard. The sensitivity and specificity of MRI in predicting symptomatic disc using defined criteria was 94% and 77%. The sensitivities and specificity of high intensity zones was 27% and 87% and for end plate changes was 32% and 98% respectively. In 14 patients (25%) the findings of MRI and discography did not correlate.

In conclusion though MRI is an excellent investigation for assessing disc morphology it should be interpreted along with discography findings before planning fusion surgery. The proposed MRI classification is a useful aid in predicting painful degenerative disc. The utility of high intensity zones and end plate changes is limited due to low sensitivity.

The aim of this study was to evaluate the morbidity associated with carpal tunnel syndrome and the outcome following surgical treatment using the Nottingham Health Profile (NHP).

Between 1994 and 1996 we performed a prospective study of the effect of carpal tunnel release on the health status of 96 patients. The Nottingham Health Profile, a validated generic scoring system was used to assess quality of life, before and after surgery.

96 patients with 103 symptomatic hands were studied over this two year period. The patients completed a questionnaire before and 4 months after surgery. The notes were reviewed by an independent assessor and data collected with regard to duration and nature of symptoms, associated conditions, patients’ satisfaction and complications.

72 patients were satisfied with the results of surgery and 24patients were dissatisfied despite in the main clinical improvement. There was a significant improvement in the scores for pain, physical mobility and sleep 4 months following surgery in all patients.

We observed that those patients with a significantly high pre-op NHP score fared less well than cohorts, developing more frequent complications and overall were more likely to be dissatisfied with the results of surgery. This group of dissatisfied patients had previously been indistinguishable from their cohorts and were as it were invisible. The high NHP scores provided an objective way of identifying this group of individuals.

Carpal tunnel syndrome had a notable impact on the health status of our patients. There was a significant improvement in the NHP scores 4 months following surgery.

Our findings show that outcome assessment tools have predictive value in identifying patients who may not benefit from surgery or in whom a poor result might be anticipated.