Purpose: Back pain is a significant problem in Europe with important socio-economic impact. The purpose of this study was to evaluate the incidence of spinal surgery for patients with back pain.

Sudy design: This was a retrospective Level II type study. Patient sample included five thousand and forty five patients with a five year follow up.

Methods and results: During past five years 5145 patients were seen in the back pain screening clinic. 823 patients (16%) were referred to the spine clinic (p< 0.001). 127 patients (2.47%) were operated on (p< 0.001). 106 patients (2.1%) had lumbar discectomy/decompression, 9 (0.59%) cervical discectomy, 3 (0.06%) pars reconstruction, 9 (0.17%) fusion and PLIF for spondylolisthesis, 5 (0.1%) decompression for spinal stenosis and 1 (0.01%) subtraction osteotomy for kyphosis. 5 patients (0.1%) were referred with “red flag” symptoms: 4 with spinal stenosis and 1 with tumour. 17 patients (0.3%) had discogram. 4 of them went for surgery: 1 had L4/5 PLIF, 2 L5/S1PLIF and 1 L5/S1 discectomy. 289 patients (5.6%) had nerve root blockade. Following NRB 47 patients (0.9%) had discectomy/decompression (p< 0.001). 62 patients had discectomy/decompression without previous NRB. L5/S1 discectomy was the most common (48 pts; 0.9%). 86 patients (1.7%) had facet joint injections. 8 patients (0.15%) had surgery following FJI (p< 0.001). 1 patient had L4 nerve root decompression, 3 L4/5 discectomy, 1 L5/S1 nerve rot decompression, 1 alartransverse fusion and 1 L5/S1 PLIF. 465 patients (9%) did not have nerve root blocks or facet joint injections. 3 patients (0.06%) had epidural injections of local anaesthetic and steroid.

Conclusion: Spinal surgery is not commonly performed in patients with back pain. Majority of patients can be treated conservatively. Prior to surgery nerve root blocks and facet joint injections are useful in selected patients.

Purpose: Neck disorders, including both neck pain and injuries, are significant and increasing problem worldwide. The purpose of this study was to assess progression and current condition of patients with neck pain five years after initial treatment in the Back Pain Screening Clinic.

Study design: This study was a randomised cohort Level I study. We randomly selected and reassessed one hundred patients with the neck pain who were treated conservatively out of the first one thousand of patients seen in our clinic five years ago. Outcome measures included SF36 (PCS and MCS), ODI, VAS, HA and DS scores.

Methods and results: One hundred randomly selected patients were interviewed and assessed for initial complaint, progression of symptoms, time out of work, litigation, other treatments and BPSC treatment satisfaction. BPSC treatment consisted of the patient assessment, advice, education, reassurance or course of physiotherapy. All of the patients were treated conservatively. 46 male and 54 female patients with mean male age 44.85 years (SD=14.43) and mean female age 48.56 (SD=15.39) were included in the study. In 72 patients pain started spontaneously. 15 patients had pain related to industrial injury/RTA. 6 patients were excluded from the study (4 with no data available, 1 child, 1 death). Mean time out of work for patients with spontaneous onset pain was 3 weeks (SD 1.12) and for patients with industrial injury/RTA 29.24 weeks (SD 20.92) (p=0.003). Analyzing outcome measures first vs 5y showed: SF36 PCS mean 30.04 vs 51.24 (SD 7.18 vs 6.38) (p< 0.001), MCS mean 30.63 vs 53.0 (SD 11 vs 6.10) (p< 0.001), ODI 41.72 vs 13.22 (SD 19.65 vs 8.41) (p< 0.001), HA mean 8.72 vs 2.37 (SD 4.54 vs 1.32) (p< 0.001), DS mean 6.71 vs 2.01 (SD 4.12 vs 1.20) (p< 0.001) and VAS mean 4.32 vs 0.84 (SD 2.18 vs 1.03) (p< 0.001). Using the patient satisfaction questionnaire, 93% of patients found BPSC treatment useful.

Conclusion: Significant symptomatic improvement is found in this cohort group of patients five years after initial treatment in BPSC. Time out of work is significantly increased in patients pursuing litigation compared with patients with spontaneous onset of neck pain (3/52 vs 29.24/52, p=0.003).

Purpose: Study purpose was to assess progression and current condition of patients with back pain five years after initial conservative treatment in BPSC.

Methods and results: 100 from the first 1000 patients were randomly selected. 46 male mean age 44.85 and 54 female patients mean age 48.56 years were assessed by interview and questionnaires for symptoms progression, time out of work, litigation, other treatments and treatment satisfaction. In 72 patients pain started spontaneously. 15 had pain related to industrial injury/RTA. 3 patients had neck pain and 3 lower back pain related to sports injury. 3 females had postpartum back pain. 6 patients were excluded from the study (4 no data available, 1 child, 1 death). Mean time out of work for patients with spontaneous back pain was 3.07 weeks (SD 1.83) and for patients with industrial injury/RTA 23.42 weeks (SD 39.92) (p=0.003). Analyzing outcome measures 1 vs 5y showed: SF36 PCS mean 31.99 vs 50.53 (SD 7.38 vs 6.28) (p< 0.001), MCS mean 37.63 vs 53.0 (SD 11.10 vs 6.15) (p< 0.001), ODI 40.71 vs 13.94 (SD 20.65 vs 9.41) (p< 0.001), HA mean 8.81 vs 2.96 (SD 4.64 vs 1.91) (p< 0.001), DS mean 6.51 vs 2.26 (SD 4.32 vs 1.40) (p< 0.001) and VAS mean 4.01 vs 0.94 (SD 2.08 vs 1.23) (p< 0.001). 93% patients found BPSC treatment useful.

Conclusion: Significant symptomatic improvement is seen in patients five years after initial BPSC treatment. Time out of work is significantly increased in patients pursuing litigation compared with patients with spontaneous onset of back pain.

Purpose: Purpose of the study was to evaluate the incidence of spinal surgery for patients with back pain.

Methods and results: During past five years 5145 patients were seen in the back pain screening clinic. 823 patients (16%) were referred to the spine clinic (p< 0.001). 127 patients (2.47%) were operated on (p< 0.001).106 patients (2.1%) had lumbar discectomy/decompression, 9 (0.59%) cervical discectomy, 3 (0.06%) pars reconstruction, 9 (0.17%) fusion and PLIF for spondylolisthesis, 5 (0.1%) decompression for spinal stenosis and 1 (0.01%) subtraction osteotomy for kyphosis. 5 patients (0.1%) were referred with “red flag” symptoms: 4 with spinal stenosis and 1 with tumour. 17 patients (0.3%) had discogram. 4 of them went for surgery: 1 had L4/5 PLIF, 2 L5/S1PLIF and 1 L5/S1 discectomy. 289 patients (5.6%) had nerve root blockade. Following NRB 47 patients (0.9%) had discectomy/decompression (p< 0.001). 62 patients had discectomy/decompression without previous NRB. L5/S1 discectomy was the most common (48 pts; 0.9%). 86 patients (1.7%) had facet joint injections. 8 patients (0.15%) had surgery following FJI (p< 0.001). 1 patient had L4 nerve root decompression, 3 L4/5 discectomy, 1 L5/S1 nerve rot decompression, 1 alartransverse fusion and 1 L5/S1 PLIF. 465 patients (9%) did not have nerve root blocks or facet joint injections. 3 patients (0.06%) had epidural injections of local anaesthetic and steroid.

Conclusion: Spinal surgery is not commonly performed in patients with back pain. Majority of patients can be treated conservatively. Prior to surgery nerve root blocks and facet joint injections are useful in selected patients.

Introduction: Reconstruction of ruptured anterior cruciate ligament is a commonly performed orthopaedic procedure. There are many ways of reconstructing this ligament. One method of doing so is to harvest a tendon graft from the hamstring muscles and use it as part of the reconstruction. The tendon is usually harvested by passing a tendon stripper along the length of the tendon from an anterior knee incision. The semitendinosus and the gracilis are the hamstring muscles whose tendons are used for this. A recent case study reported injury to the sciatic nerve during the harvest of semitendinosus graft. Although morbidity arising from iatrogenic injury to nerves at the anterior aspect of the knee has been well documented, little has been written about the relationship of the sciatic nerve to the semitendinosus and gracilis in the posterior thigh. This study proposes to look at this anatomical relationship.

Method: 20 legs on ten cadavers underwent the same dissection to expose the semitendinosus tendon, gracilis tendon and the sciatic nerve while maintaining their anatomical relationships. In all cases the gracilis lay further away from the sciatic nerve than the semiten-dinosus tendon. As the semitendinosus tendon was in between the semitendinosus and the sciatic nerve in all instances it was decided not to measure the distance between gracilis and the sciatic nerve. The distance between the closest point of the sciatic nerve to the tendon of semitendinosus was measured at the joint line and at intervals of 20 mm from the joint line.

Results: In 45 % of the subjects the sciatic nerve and the semitendinosus tendon gradually moved further apart as the measurements were taken more proximally in the leg. In 10 % they consistently moved apart from 6 cm from the joint line onwards. In another 10% they moved consistently apart from the 8cm from the joint line measurement and in 15 % they moved apart consistently from 12 cm from the joint line. In the remaining 20 % the sciatic nerve and the semitendinosus tendon did not consistently move apart from each other until after 14 cm from the joint line. In one subject (a female of small stature) it was noted that the semitendinosus muscle lay almost directly upon the sciatic nerve. In 6 subjects the minimum distance between the sciatic nerve and the semitendinosus tendon was less than 18mm. In one subject the distance between the sciatic nerve and the semitendinosus tendon was found to be 10 mm at the closest point and remained in close proximity for a further 4 cm.

Conclusion: In 55 % of our patients the sciatic nerve did not consistently move further away from the semi-tendinosus tendon as it was measured more proximally. In some subjects the minimum distance between the nerve and the tendon was less than 2 cm. Both these facts would put the sciatic nerve at risk during tendon harvesting if the tendon stripper were to move outside of the tendon during the procedure.

Aims: To confirm that the augmented (MGH) Becker extensor tendon repair is a strong four-strand technique that allows earlier mobilisation of repaired tendons after only 3/52 of postoperative static splinting and to assess functional outcome using revised disabilities of arm, shoulder and hand (DASH) score.

Methods: In this prospective study we used the augmented Becker (MGH) suturing technique with Ethilon. Postoperatively patients were immobilised 3 weeks in volar splint and then fully mobilised with physiotherapy. 3/12 postoperatively all patients had final assessment in hand clinic for: pulp to palm distance, power grip, pinch grip, pain, Dragan criteria of progress, total active motions (TAM) of the fingers and revised DASH score.

Results: Eighteen patients had extensor tendon lacerations repaired with augmented Becker (MGH) technique. Results were compared with the uninjured hand and statistically evaluated. At the final assessment the average pulp to palm distance was 0cm. All patients had good pinch and power grip (> 80% of uninjured hand for dominant hand and > 60% for non-dominant hand) and were free of pain with excellent progress using Dragan criteria. Average TAM was 268° without statistically significant difference between this and the uninjured side. Average scaled DASH score was 7.6 and within normal values. We had no wound complications or ruptures of repaired tendons.

Conclusion: Augmented (MGH) Becker technique is a strong four-strand extensor tendon repair technique that allows early mobilization of patients after only 3/52 of static splinting postoperatively. Injured fingers can then be safely mobilized with expected full return of movements at 3/12 postoperatively.

Aims: To assess the value of measuring subpopulations of T and B lymphocytes in children with bone tumours as an immunodiagnostic procedure in primary diagnosis of tumours.

Methods: In this prospective study blood samples were obtained from 36 patients aged 04–16 presenting with bone tumours in Cappagh Orthopaedic Hospital. Measurements in Immunology laboratory were based upon the principle of Ortho Cytoron Absolute flowcytometry. Levels of CD3 (Total T cells), CD4 (Helper cells), CD8 (Suppressor cells), Helper/Suppressor ratio and CD19 (B cells) were measured. Histological diagnosis of tumours was obtained by histopathological investigation of biobsy samples and flow cytometry results allocated accordingly.

Results: Of 36 patients, 12 (33.12%) had osteosarcoma, 10 (27.7%) Ewing’s sarcoma, 4 (11.1%) giant cell tumour and 10 (27.7%) osteomyelitis. Median values of lymphocytes were within normal values in patients with tumours other than oseomyelitis. In children with osteomyelitis median values were: CD3 2456, CD4 1479, CD8 929, Help/Sup ratio 1.8 and CD19 560 and all significantly raised. Confidence intervals were: CD3 467, CD4 292, CD8 470, and CD19 148. IN order to confidently outrule or confirm the diagnosis of osteomyelitis we measured the cut off point values of lymphocytes (the highest value in other patients groups). The cut off point values were found to be: CD3 2420, CD4 1400, CD8 873 and CD19 550.

Conclusions: The main use of measuring T and B lymphocytes response is in establishing the correct diagnosis between suspected osteomyelitis and other bone tumours. The CD3, CD4, CD8 and CD19 were significantly raised in children with osteomyelitis in contrast to other causes. Levels of CD3, CD4, CD8 and CD19 above the presented cut off values are an important and accurate confirming factor for the diagnosis of suspected osteomyelitis.