Informed consent is a very important part of surgical treatment. In this paper, we report a number of legal judgements in spinal surgery where there was no criticism of the surgical procedure itself. The fault that was identified was a failure to inform the patient of alternatives to, and material risks of, surgery, or overemphasizing the benefits of surgery. In one case, there was a promise that a specific surgeon was to perform the operation, which did not ensue. All of the faults in these cases were faults purely of the consenting process. In many cases, the surgeon claimed to have explained certain risks to the patient but was unable to provide proof of doing so. We propose a checklist that, if followed, would ensure that the surgeon would take their patients through the relevant matters but also, crucially, would act as strong evidence in any future court proceedings that the appropriate discussions had taken place. Although this article focuses on spinal surgery, the principles and messages are applicable to the whole of orthopaedic surgery. Cite this article:
Interleukin 18 (IL-18) is a regulatory cytokine that degrades the disc matrix. Bone morphogenetic protein-2 (BMP-2) stimulates synthesis of the disc extracellular matrix. However, the combined effects of BMP-2 and IL-18 on human intervertebral disc degeneration have not previously been reported. The aim of this study was to investigate the effects of the anabolic cytokine BMP-2 and the catabolic cytokine IL-18 on human nucleus pulposus (NP) and annulus fibrosus (AF) cells and, therefore, to identify potential therapeutic and clinical benefits of recombinant human (rh)BMP-2 in intervertebral disc degeneration. Levels of IL-18 were measured in the blood of patients with intervertebral disc degenerative disease and in control patients. Human NP and AF cells were cultured in a NP cell medium and treated with IL-18 or IL-18 plus BMP-2. mRNA levels of target genes were measured by real-time polymerase chain reaction, and protein levels of aggrecan, type II collagen, SOX6, and matrix metalloproteinase 13 (MMP13) were assessed by western blot analysis.Objectives
Methods
The aims of this study were to describe the prevalence of previous
lumbar surgery in patients who undergo total hip arthroplasty (THA)
and to investigate their patient-reported outcomes (PROMs) one year
post-operatively. Data from the Swedish Hip Arthroplasty Register and the Swedish
Spine Register gathered from 2002 to 2013 were merged to identify
a group of patients who had undergone lumbar surgery before THA
(n = 997) and a carefully matched one-to-one control group. We investigated
differences in the one-year post-operative PROMs between the groups.
Linear regression analyses were used to explore the associations
between previous lumbar surgery and these PROMs following THA. The
prevalence of prior lumbar surgery was calculated as the ratio of
patients identified with previous lumbar surgery between 2002 and
2012, and divided by the total number of patients who underwent
a THA in 2012.Aims
Patients and Methods
The United States and Canada are in the midst
of an epidemic of the use, misuse and overdose of opioids, and deaths
related to overdose. This is the direct result of overstatement
of the benefits and understatement of the risks of using opioids
by advocates and pharmaceutical companies. Massive amounts of prescription
opioids entered the community and were often diverted and misused.
Most other parts of the world achieve comparable pain relief using
fewer opioids. The misconceptions about opioids that created this epidemic are
finding their way around the world. There is particular evidence
of the increased prescription of strong opioids in Europe. Opioids are addictive and dangerous. Evidence is mounting that
the best pain relief is obtained through resilience. Opioids are
often prescribed when treatments to increase resilience would be
more effective. Cite this article:
The aim of this study was to investigate the clinical and radiographic
outcomes of microendoscopic laminotomy in patients with lumbar stenosis
and concurrent degenerative spondylolisthesis (DS), and to determine
the effect of this procedure on spinal stability. A total of 304 consecutive patients with single-level lumbar
DS with concomitant stenosis underwent microendoscopic laminotomy
without fusion between January 2004 and December 2010. Patients
were divided into two groups, those with and without advanced DS
based on the degree of spondylolisthesis and dynamic instability. A
total of 242 patients met the inclusion criteria. There were 101
men and 141 women. Their mean age was 68.1 years (46 to 85). Outcome
was assessed using the Japanese Orthopaedic Association and Roland
Morris Disability Questionnaire scores, a visual analogue score
for pain and the Short Form Health-36 score. The radiographic outcome
was assessed by measuring the slip and the disc height. The clinical
and radiographic parameters were evaluated at a mean follow-up of
4.6 years (3 to 7.5).Aims
Patients and Methods
The aim of this study was to compare the effect of a percutaneous
radiofrequency heat lesion at the medial branch of the primary dorsal
ramus with a sham procedure, for the treatment of lumbar facet joint
pain. A randomised sham-controlled double blind multicentre trial was
carried out at the multidisciplinary pain centres of two hospitals.
A total of 60 patients aged >
18 years with a history and physical
examination suggestive of facet joint pain and a decrease of ≥ 2
on a numerical rating scale (NRS 0 to 10) after a diagnostic facet
joint test block were included. In the treatment group, a percutaneous
radiofrequency heat lesion (80oC during 60 seconds per
level) was applied to the medial branch of the primary dorsal ramus.
In the sham group, the same procedure was undertaken without for
the radiofrequency lesion. Both groups also received a graded activity
physiotherapy programme. The primary outcome measure was decrease
in pain. A secondary outcome measure was the Global Perceived Effect scale
(GPE).Aims
Patients and Methods
The aims of this study were to examine the rate at which the
positioning of the acetabular component, leg length discrepancy
and femoral offset are outside an acceptable range in total hip
arthroplasties (THAs) which either do or do not involve the use
of intra-operative digital imaging. A retrospective case-control study was undertaken with 50 patients
before and 50 patients after the integration of an intra-operative
digital imaging system in THA. The demographics of the two groups
were comparable for body mass index, age, laterality and the indication
for surgery. The digital imaging group had more men than the group without.
Surgical data and radiographic parameters, including the inclination
and anteversion of the acetabular component, leg length discrepancy,
and the difference in femoral offset compared with the contralateral
hip were collected and compared, as well as the incidence of altering
the position of a component based on the intra-operative image.Aims
Patients and Methods
Chronic conditions of the wrist may be difficult to manage because
pain and psychiatric conditions are correlated with abnormal function
of the hand. Additionally, intra-articular inflammatory cytokines
may cause pain. We aimed to validate the measurement of inflammatory cytokines
in these conditions and identify features associated with symptoms. The study included 38 patients (18 men, 20 women, mean age 43
years) with a chronic condition of the wrist who underwent arthroscopy.
Before surgery, the Self-Rating Depression Scale (SDS), Hand20 questionnaire
and a visual analogue scale (VAS) for pain were used. Cytokine and
chemokine levels in the synovial fluid of the wrist were measured
using enzyme-linked immunosorbent assays and correlations between
the levels with pain were analysed. Gene expression profiles of
the synovial membranes were assessed using quantitative polymerase
chain reaction.Aims
Patients and Methods
The February 2015 Spine Roundup360 looks at: Paracetamol use for lower back pain; En-bloc resection of vertebra reported for the first time; Spinopelvic disassociation under the spotlight; Hope for back pain; Disc replacement and ACDF equivalent in randomised study; Interspinous process devices ineffective
