Multidisciplinary approach to L3/L4 lumbar disc prolapse masquerading as focal limb myositis-a radiological challenge.

Prolapsed intervertebral discs are commonly associated with back ache and sciatica. Management is often conservative with analgesia and physiotherapy. Nerve root injections and discectomy procedures are used where conservative measures fail.

Obesity and recurrent intervertebral disc prolapse after lumbar microdiscectomy.

Introduction: The primary aim of this study was to investigate the relationship between obesity and recurrent intervertebral disc prolapse (IDP) following lumbar microdiscectomy.

Methods: A retrospective review of case notes from 2008 to 2012 was conducted for all patients who underwent single level lumbar microdiscectomy performed by a single surgeon. All patients were followed up at two weeks and six weeks following surgery, and given an open appointment for a further six months.

Does rectal examination have any value in the clinical diagnosis of cauda equina syndrome?

Purpose: This study aims to quantify the value of digital rectal examination (DRE) in the clinical diagnosis of cauda equina syndrome.

Methods: A retrospective case note review was performed on all patients referred to a University Teaching Hospital over a one-year period with documented suspicion of cauda equina syndrome. All Patients underwent MRI scanning to either confirm or rule out the diagnosis.

A study investigating the validity of modified Tokuhashi score to decide surgical intervention in patients with metastatic spinal cancer.

Purpose: Predicted survival of a patient is the most important parameter that helps to guide the treatment of a patient with metastatic spinal cancer. We aimed to investigate the reliability of modified Tokuhashi score in the decision-making process in patients with metastatic spinal cancer.

Methods: We performed a review of our prospectively collected Metastatic Cancer Database over a period of 4 years (2007-2010).

Spinal subdural hematoma as a complication of spinal surgery: can it happen without dural tear?

Post spinal surgery subdural hematoma is a rare entity. This is a report of a case of acute post-operative spinal subdural hematoma, without any dural injury. The case was managed expectantly and went on to complete resolution of the hematoma and full clinical recovery.

Accuracy of prognostic scores in decision making and predicting outcomes in metastatic spine disease.

Introduction: Management of metastatic spinal disease has changed significantly over the last few years. Different prognostic scores are used in clinical practice for predicting survival. The aim of this study was to assess the accuracy of prognostic scores and the role of delayed presentation in predicting the outcome in patients with metastatic spine disease.

Social implications of balloon kyphoplasty: prospective study from a single UK centre.

Purpose: The incidence of osteoporotic fractures is increasing with an ageing population. This has potential consequences for health services, patients and their families. Treatment of osteoporotic vertebral compression fractures (OVCFs) has been limited to non-surgical measures so far.

Impact of kyphoplasty treatment for vertebral compression fractures on pain and function in 105 patients.

Purpose Of The Study: Vertebral compression fractures are very common. Symptomatic relief with conservative therapy is often difficult to achieve. Balloon kyphoplasty is a relatively new technique which stabilises the vertebral body and restores spinal alignment in recent fractures, it achieves significant pain relief and improved functional outcome is reported.

Spondylodiscitis in children: a retrospective series.

We retrospectively reviewed the records of 16 children treated for spondylodiscitis at our hospital between 2000 and 2007. The mean follow-up was 24 months (12 to 38). There was a mean delay in diagnosis in hospital of 25 days in the ten children aged less than 24 months.

Acetabular surgical units: a directory for the United Kingdom.

We present the first directory of the specialist acetabular surgical units throughout the United Kingdom. Previously there has not been any directory of acetabular surgeons in the UK as held by any governmental or healthcare agency. We have established that acetabular fracture fixation cases were performed at 33 NHS hospitals in the UK in 2003-2004.

The 'silent' compartment syndrome.

Intractable pain out of proportion to the injury sustained is considered to be the earliest and most reliable indicator of a developing compartment syndrome. We report 4 cases where competent sensate patients developed compartment syndromes without any significant pain. The first patient developed a painless compartment syndrome in the well leg following surgery for femoral fracture on the other side.

[Surgical treatment of spinal infections].

Purpose Of The Study: Although great advances have been made in both radiological diagnosis and antibiotic therapy of microbial infections, the treatment of spinal infections remains a major clinical challenge. Many of the patients affected are referred to spinal units with long delays. The general population is ageing and the number of immunocompromised patients, as well as the number of operative procedures for spinal disorders are increasing.

The AO 8mm solid tibial nail is not defunct.

The AO 8mm unreamed tibial nail (UTN) is an established implant that has in some publications been associated with high rate of distal locking screw breakage and failure. Larger reamed nails are now increasingly favoured. We have used the 8mm UTN employing all three available distal screws when appropriate and with a restricted initial weight-bearing regimen.

Acetabular fractures in the UK. What are the numbers?

We have established a nationwide directory of the specialist surgical units and their Lead Consultants with expertise in acetabular fracture surgery throughout the UK. Our directory has facilitated an estimation of the total numbers of operative acetabular fracture cases managed annually in the UK, as reported by those actually providing this specialist service. Previously the total number of acetabular injuries admitted and operated on in the UK was not known and there was no directory of acetabular surgeons in the UK.

Thromboprophylaxis for acetabular injuries in the UK What prophylaxis is used?

Due to chronic underfunding and the absence of a comprehensive and coordinated national approach to the management of acetabular trauma throughout the UK, patients can incur prolonged recumbancy. We have performed a postal questionnaire to establish the current clinical practice in the specialist pelvic and acetabular units throughout the UK, with respect to time to surgery from injury, thromboprophylaxis, and surveillance. We have identified 21 units, and 37 surgeons in the NHS who deal with acetabular trauma.

Orthopaedic trauma care: a two-tier system?

Orthopaedic trauma requiring surgical admission presents to our hospitals right throughout the week. However, the level of service provided to trauma patients appears to fluctuate with more surgery facilities available during weekday "office-hours" with reduced facilities at the weekend. The National Confidential Enquiry into Peri-operative Deaths (NCEPOD) in 1999 laid down guidelines for orthopaedic trauma surgery in elderly patients clearly stating that no elderly patient requiring an urgent operation should have to wait for more than 24 h once fit for surgery.

The mannequin sign.

Study Design: Prospective observational study.

Objectives: The critical appraisal of the mannequin sign in the validation of patients with symptoms of sciatica.

Summary Of Background Data: Sixty-five consecutive patients with magnetic resonance imaging-proven lumbar disc herniation and symptoms of sciatica.

Breast cancer bone metastasis in femur: surgical considerations and reconstruction with Long Gamma Nail.

Aim: The femur is the most common long bone involved in metastatic breast cancer. Several studies have been published on the surgical management of metastatic disease of the femur. However, only few studies have been published specifically on the outcomes following reconstruction of femoral metastasis from breast cancer using a third generation intramedullary nail.

Cervical cord compression in an elderly patient with Hurler's syndrome: a case report.

Study Design: A case of cervical cord compression in an elderly lady with Hurler's syndrome is reported.

Objective: To report the occurrence of cervical cord compression in a 56-year-old patient of Hurler's syndrome, making her the oldest patient with Hurler's. The case report also highlights the appropriate management that could be given to this group of difficult patients.

Subtrochanteric metastatic lesions treated with the long gamma nail.

From 1996 to 2002, 39 consecutive intramedullary reconstructions (three bilateral) in 36 patients were performed in a group of subtrochanteric femoral metastatic bone disease using the long gamma nail (LGN). Reconstruction was performed prophylactically in 28 femurs and, for actual fractures in 11. All patients achieved good functional results with pain relief and improved mobility.

Thoracic spinal cord injury without radiographic abnormality in a skeletally mature patient: a case report.

Study Design: A case of thoracic spinal cord injury without radiographic abnormality in a skeletally mature patient is reported.

Objectives: To report, for the first time in the literature, a case of thoracic spinal cord injury without radiographic abnormality or any ligamentous injury in a skeletally mature patient, and to propose a unique mechanism of spinal cord traction injury resulting from associated bilateral high-energy lower limb injuries. SUMMERY OF BACKGROUND DATA: Thoracic spinal cord injury without radiographic abnormality is extremely uncommon in skeletally mature patients.

"Spinolith": case report of a loose body in the spinal canal.

Study Design: Case report. A hitherto unreported finding of a bony loose body found lying in the spinal canal causing spinal canal stenosis is presented.

Summary Of Clinical Details: A 68-year-old, fit man presented with a history of progressive neurologic claudication and neurologic deficit in both his lower limbs.

Mortality following surgery for proximal femoral fractures in centenarians.

Although the number of centenarians in our population is increasing, mortality rates following hip fracture in this group of patients has not yet been reported. The medical records of a consecutive series of 13 centenarians with proximal femoral fractures who presented to the Derbyshire Royal Infirmary over a 20 year period were retrospectively reviewed. The majority of patients were female (M:F 2:11) and had suffered intertrochanteric fractures.

Analgesia requirements following hip fracture in the cognitively impaired.

The analgesia received in the 1st week of treatment by 100 consecutive acute hip fracture patients (88 female) was prospectively studied. A modified mental test was performed on all patients prior to surgery. Patients with cognitive impairment (modified mental score <5) received only 74% of the paracetamol, 43% of the non-steroidal anti-inflammatory drugs (NSAIDs), 52% of the opioid and 64% of the morphine that cognitively intact patients received.