A comparison of patient-reported outcome measures after spinal surgery.

Minimal clinically important differences (MCID) in the scores of patient-reported outcome measures allow clinicians to assess the outcome of intervention from the perspective of the patient. There has been significant variation in their absolute values in previous publications and a lack of consistency in their calculation. The purpose of this study was first, to establish whether these values, following spinal surgery, vary depending on the surgical intervention and their method of calculation and secondly, to assess whether there is any correlation between the two external anchors most frequently used to calculate the MCID.

Dural tears in primary decompressive lumbar surgery. Is primary repair necessary for a good outcome?

Study Design: Case control series with prospective data collection.

Objective: To establish whether incidental durotomy treated without primary suture repair adversely affects the outcome following lumbar surgery in the longer term.

Method: Outcome scores from a prospective database were used for an audit of dural tears in primary lumbar decompressive surgery.

Characterizing the rheology of fluidized granular matter.

In this study we characterize the rheology of fluidized granular matter subject to secondary forcing. Our approach consists of first fluidizing granular matter in a drum half filled with grains via simple rotation and then superimposing oscillatory shear perpendicular to the downhill flow direction. The response of the system is mostly linear, with a phase lag between the grain motion and the oscillatory forcing.

Variations in selective nerve root block technique.

Introduction: Much literature reports on selective nerve root blocks (SNRBs) in cases of lumbosacral radiculopathy. Unfortunately, authors only inconsistently reveal the exact needle tip position relative to the causative pathology at the time of injection. Different injection sites may provide different symptomatic benefits.

A comparative study of the outcomes of primary and revision lumbar discectomy surgery.

The outcome of surgery for recurrent lumbar disc herniation is debatable. Some studies show results that are comparable with those of primary discectomy, whereas others report worse outcomes. The purpose of this study was to compare the outcome of revision lumbar discectomy with that of primary discectomy in the same cohort of patients who had both the primary and the recurrent herniation at the same level and side.

Is cauda equina syndrome linked with obesity?

No previous studies have examined the physical characteristics of patients with cauda equina syndrome (CES). We compared the anthropometric features of patients who developed CES after a disc prolapse with those who did not but who had symptoms that required elective surgery. We recorded the age, gender, height, weight and body mass index (BMI) of 92 consecutive patients who underwent elective lumbar discectomy and 40 consecutive patients who underwent discectomy for CES.

The relationship of pre- and postoperative median and ulnar nerve conduction measures to a self-administered questionnaire in carpal tunnel syndrome.

Study Aims: Following carpal tunnel release (CTR), only very modest correlations have been found between subjective symptoms and function indexes compared to neurophysiological measures. The objective of this study was to evaluate this relationship by comparing the self-administered Boston symptom severity score and function severity score questionnaire against nerve conduction studies (NCS) before and after CTR using two different electrophysiological techniques.

Patients And Methods: Carpal tunnel release was performed in 51 patients (62 hands).

Skeletal metastases - the role of the orthopaedic and spinal surgeon.

Developments in oncological and medical therapies mean that life expectancy of patients with metastatic bone disease (MBD) is often measured in years. Complications of MBD may dramatically and irreversibly affect patient quality of life, making the careful assessment and appropriate management of these patients essential. The roles of orthopaedic and spinal surgeons in MBD generally fall into one of four categories: diagnostic, the prophylactic fixation of metastatic deposits at risk of impending fracture (preventative surgery), the stabilisation or reconstruction of bones affected by pathological fractures (reactive surgery), or the decompression and stabilisation of the vertebral column, spinal cord, and nerve roots.

Reducing the economic impact of carpal tunnel surgery.

A nurse-led carpal tunnel service was started in Leicester in 1999. Many developments in the service have been patient-driven. A large proportion of our patients are not salaried and many had expressed concerns about the amount of time taken off work after surgery.

Searching for differences in race: is there evidence for preferential detection of other-race faces?

Previous research has suggested that like animal and social fear-relevant stimuli, other-race faces (African American) are detected preferentially in visual search. Three experiments using Chinese or Indonesian faces as other-race faces yielded the opposite pattern of results: faster detection of same-race faces among other-race faces. This apparently inconsistent pattern of results was resolved by showing that Asian and African American faces are detected preferentially in tasks that have small stimulus sets and employ fixed target searches.

Getting patients back to work after carpal tunnel surgery.

This article describes the condition known as carpal tunnel syndrome and reviews a carpal tunnel service that was started in Leicester in 1999. We look at how the service has developed to meet patient needs, and how we now aim to return patients back to function and employment as quickly as possible after surgery.

Feedback control of unstable cellular solidification fronts.

We present a feedback control scheme to stabilize unstable cellular patterns during the directional solidification of a binary alloy. The scheme is based on local heating of cell tips which protrude ahead of the mean position of all tips in the array. The feasibility of this scheme is demonstrated using phase-field simulations and, experimentally, using a real-time image processing algorithm, to track cell tips, coupled with a movable laser spot array device to heat the tips locally.

Nurse-led management of carpal tunnel syndrome: an audit of outcomes and impact on waiting times.

Introduction: This article describes the outcome of a nurse-led service developed to manage patients referred with a presumptive diagnosis of carpal tunnel syndrome.

Patients And Methods: We developed a rapid-access service in response to unacceptable waiting times for patients with carpal tunnel syndrome. The service was developed around the role of a nurse practitioner providing a single practitioner pathway from first clinic appointment, through surgery to discharge.

The long-term outcome after central cord syndrome: a study of the natural history.

We studied 32 patients with central cord syndrome who were managed conservatively. Six were under 50 years of age (group 1), 16 between 50 and 70 years (group 2) and ten over 70 years (group 3). At the time of discharge all patients in group 1 could walk independently and had good bladder control compared with 11 (69%) and 14 (88%) in group 2 and four (40%) and two (20%) in group 3, respectively.

Delayed focal neurological deficit secondary to a cervico-thoracic spinal cord epidural haematoma.

This is a report of an elderly woman who developed focal neurological deficit in association with a cervico-thoracic spinal epidural haematoma. Symptoms developed several days after the initial injury and subsequently resolved without surgical intervention. The unusual features of this presentation are discussed.

Deep hand infection complicating chickenpox in an otherwise healthy infant.

Chickenpox is a common childhood infection, and complications are rare in the healthy child. This report describes a significant complication of varicella in an otherwise healthy infant.

Pain relief following tennis elbow release.

We studied the outcome of tennis elbow release in 27 patients at an average of 29.6 months after surgery. We found that 44% of patients had obtained complete pain relief, 37% of patients experienced occasional pain and 19% of patients still experienced moderate pain.

Markers of data quality in computer audit: the Manchester Orthopaedic Database.

This study investigates the efficiency of the Manchester Orthopaedic Database (MOD), a computer software package for record collection and audit. Data is entered into the system in the form of diagnostic, operative and complication keywords. We have calculated the completeness, accuracy and quality (completeness x accuracy) of keyword data in the MOD in two departments of orthopaedics (Departments A and B).

The AO classification of long bone fractures: an early study of its use in clinical practice.

Over a period of 6 months, 543 long bone fractures were classified using the AO classification system. Factors important in determining the management of fractures occurring in three regions; hip, forearm and tibia, were identified. In hip fractures, we found that the anatomical configuration of the fracture, and therefore its classification, generally determined management.

Fenoterol plus ipratropium ('Duovent') aerosol therapy delivered by a tube spacer.

A randomized crossover study was carried out in 12 patients with reversible airflow obstruction to investigate the bronchodilator effects of a single metered dose of fenoterol hydrobromide (200 micrograms) plus ipratropium bromide (80 micrograms) delivered by the standard aerosol inhaler or by the inhaler with an extension tube spacer. The results of lung function tests showed that there were significant increases from baseline values in FEV1, FVC and PEFR by 15 minutes using both drug delivery methods, and the improvement in PEFR was maintained for at least 8 hours in 11 of the 12 patients. Although no significant differences in the results was demonstrated between the two methods, which were used correctly by all the participants, it is suggested that the spacer device method would be particularly useful for patients who have difficulty in co-ordinating drug delivery with inhalation.