People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from recommended non-surgical treatments. However, National Institute for Health and Care Excellence (NICE) 2016 guidelines recommended not offering spinal fusion surgery for adults with LBP, except as part of a randomized clinical trial. This survey aims to describe UK clinicians’ views about the suitability of patients for such a future trial, along with their views regarding equipoise for randomizing patients in a future clinical trial comparing lumbar spine fusion surgery to best conservative care (BCC; the FORENSIC-UK trial). An online cross-sectional survey was piloted by the multidisciplinary research team, then shared with clinical professional groups in the UK who are involved in the management of adults with severe, persistent LBP. The survey had seven sections that covered the demographic details of the clinician, five hypothetical case vignettes of patients with varying presentations, a series of questions regarding the preferred management, and whether or not each clinician would be willing to recruit the example patients into future clinical trials.Aims
Methods
Ventral screw osteosynthesis is a common surgical
method for treating fractures of the odontoid peg, but there is still
no consensus about the number and diameter of the screws to be used.
The purpose of this study was to develop a more accurate measurement
technique for the morphometry of the odontoid peg (dens axis) and
to provide a recommendation for ventral screw osteosynthesis. Images of the cervical spine of 44 Caucasian patients, taken
with a 64-line CT scanner, were evaluated using the measuring software
MIMICS. All measurements were performed by two independent observers.
Intraclass correlation coefficients were used to measure inter-rater
variability. The mean length of the odontoid peg was 39.76 mm (. sd. 2.68).
The mean screw entry angle α was 59.45° (. sd. 3.45). The
mean angle between the screw and the ventral border of C2 was 13.18°
(. sd. 2.70), the maximum possible mean converging angle of
two screws was 20.35° (. sd. 3.24). The measurements were
obtained at the level of 66% of the total odontoid peg length and
showed mean values of 8.36 mm (. sd. 0.84) for the inner diameter
in the sagittal plane and 7.35 mm (. sd. 0.97) in the coronal
plane. The mean outer diameter of the odontoid peg was 12.88 mm
(. sd. 0.91) in the sagittal plane and 11.77 mm (. sd. 1.09)
in the coronal plane. The results measured at the level of 90% of
the total odontoid peg length were a mean of 6.12 mm (. sd. 1.14)
for the sagittal inner diameter and 5.50 mm (. sd. 1.05) for
the coronal inner diameter. The mean outer diameter of the odontoid
peg was 11.10 mm (. sd. 1.0) in the sagittal plane and 10.00
mm (. sd. 1.07) in the coronal plane. In order to calculate
the necessary screw length using 3.5 mm cannulated screws, 1.5 mm
should be added to the measured odontoid peg length when anatomical
reduction seems possible. The
This study prospectively compared the efficacy of kyphoplasty using a Jack vertebral dilator and balloon kyphoplasty to treat osteoporotic compression fractures between T10 and L5. Between 2004 and 2009, two groups of 55 patients each underwent vertebral dilator kyphoplasty and balloon kyphoplasty, respectively. Pain, function, the Cobb angle, and the anterior and middle height of the vertebral body were assessed before and after operation. Leakage of bone cement was recorded. The post-operative change in the Cobb angle was significantly greater in the dilator kyphoplasty group than in the balloon kyphoplasty group (−9.51° ( These findings suggest that vertebral dilator kyphoplasty can facilitate better correction of kyphotic deformity and may ultimately be a safer procedure in reducing leakage of bone cement.
