Aim: This study aims to quantify pain relief and quality-of-life benefit from a diagnostic SIJ injection.

Methods: 50 consecutive patients were retrospectively recruited with unilateral low back pain, pain mapping compatible with a sacroiliac origin, tenderness over the SIJ, and no obvious source of pain in the lumbar spine. These were selected for a diagnostic SIJ injection. A structured questionnaire was completed both pre- and post-injection. Median patient age was 63. All patients were injected under fluoroscopic imaging with Triamcinolone 40mgs and 3mls Ropivacaine hydrochloride.

Results: Onset of lower back pain symptoms ranged from 1962 to 2007. 38 patients (76%) had some form of previous non-operative treatment. No patients had previous injection or surgery. 8 patients (16%) were smokers. 17 patients (34%) had a desk based job, 22 patients (44%) had a manual job, 7 patients (14%) had heavy manual jobs. 18 patients (36%) had sustained previous back injury. A visual assessment score was carried out for low back pain and pain in both legs, both pre- and post-injection. Overall, 16 patients (32%) reported no change in their symptoms, 7 (14%) reported worsening, but in 27 (54%) improvement was recorded. When considering the Oswestry Disability Index score, 18% reported no symptom change, 24% worsened and 58% improved.

Conclusion: History and physical examination can enter SIJ syndrome into the differential diagnosis, but cannot make a definitive diagnosis. Fluoroscopically guided diagnostic SIJ injection is the gold standard test for making the diagnosis whilst also conferring substantial pain relieve and quality-of-life benefit.

Conflicts of Interest: None

Source of Funding: None

We would like to present a rare case report describing a case in which new-onset tonic-clonic seizures occurred following an unintentional durotomy during lumbar discectomy and decompression. Unintentional durotomy is a frequent complication of spinal surgical procedures, with a rate as high as 17%. To our knowledge a case of new onset epilepsy has never been reported in the literature. Although dural rupture during surgery and CSF hypovolemia are thought to be the main contributing factors, one can postulate on the effects of anti-psychiatirc medication with epileptogenic properties. Amisulpride and Olanzapine can lower seizure threshold and therefore should be used with caution in patients previously diagnosed with epilepsy. However manufacturers do not state that in cases were the seizure threshold is already lowered by CSF hypotension, new onset epilepsy might be commoner. Finally, strong caution and aggressive post-operative monitoring is advised for patients with CSF hypotension in combination with possible eplieptogenic medication.

Conflict of Interest: None

Source of Funding: None

Aim: This study was a sub group analysis of a larger study. The aim was to quantify pain relief and quality-of-life benefit from a single diagnostic SIJ (Sacro-Iliac joint) injection.

Methods: Between August 2008 and February 2009, 56 consecutive patients were retrospectively recruited with unilateral low back pain, pain mapping compatible with a sacroiliac origin, tenderness over the SIJ, no obvious source of pain in the lumbar spine and no neurological deficit. These were selected for a diagnostic SIJ injection. A structured questionnaire was completed both pre- and post-injection. Median patient age was 63. All patients were injected under fluoroscopic imaging with Triamcinolone 40mgs and 3mls of 0.5% Ropivacaine hydrochloride.

Results: 6 patients were excluded from the study on the basis of incomplete answers. 38 patients (76%) had some form of previous non-operative treatment. No patients had previous injection or surgery. 8 patients (16%) were smokers. 17 patients (34%) had a desk based job, 22 patients (44%) had a manual job, 7 patients (14%) had heavy manual job. 18 patients (36%) had sustained previous back injury including rear ended road traffic accidents. A numerical rating score was carried out for low back pain and pain in the affected and unaffected leg; both pre- and post-injection. In 27 patients (54%) significant improvement was recorded, 16 patients (32%) reported no change in their symptoms, and only 7 (14%) reported worsening. When considering the Oswestry Disability Index score, 58% improved, 18% reported no symptom change, and 24% worsened. The mean pre injection Numerical Rating Score of back pain in patients who had a previous injury to the back was 7.66 and that improved to 5.72 (P = 0.0287).

Discussion: Sacroiliac joint as a potential source of back pain has had less focus following the identification of the disc pathology by Mixter and Barr. The pain from the joint is real and needs to be addressed specifically with injection as a diagnostic measure. Blanket prescription of “low back - core stability exercises” without identification of other potential non red flag causes of back pain should be discouraged. The mechanism of sacroiliac joint syndrome following road traffic accidents occur due to one leg being on the brake pedal stabilizing one half of the pelvis, whilst the opposite hemipelvis twists forward following a rear end collision.

Conclusion: History and physical examination can enter SIJ syndrome into the differential diagnosis, but cannot make a definitive diagnosis. Fluoroscopically guided diagnostic SIJ injection is the gold standard test for making the diagnosis whilst also conferring substantial pain relieve and quality-of-life benefit. This benefit is also seen in back pain following traumatic injuries including rear end motor vehicle collisions.

We compared the radiological appearances and survival of four methods of fixation of a femoral stem in 538 hips after follow-up for five or ten years. The fixation groups were: 1) press-fit shot-blasted smooth Ti-Al-V stem; 2) press-fit shot-blasted proximally ridged stem; 3) proximal hydroxyapatite (HA) coating; and 4) cementing.

Survival analysis at five to ten years showed better results in the HA-coated (100% at five to six years) and cemented stems (100% at 5 to 6 years) than in the two press-fit groups. There was a higher mean rate of migration in the smooth and ridged Ti-Al-V shot-blasted press-fit groups (0.8 mm/year and 0.6 mm/year, respectively) when compared with the HA-coated and cemented prostheses (both 0.3 mm/year). More radiolucent lines and osteolytic lesions were seen in the press-fit groups than in either the HA-coated or cemented implants, with a trend for a lower incidence of both in the HA compared with the cemented group. Proximal osteopenia increased in the press-fit and cemented prostheses with time, but did not do so in the HA group. There was a higher incidence of resorption of the femoral neck with time in the cemented group than in the other three.

We conclude that the HA and the cemented interfaces both provide secure fixation with a trend in favour of HA. The cemented prosthesis meets the suggested National Institutes of Health definition of ‘efficacious’ at ten years.