Congenital talipes equinovarus (CTEV) is a complex three-dimensional deformity with an incidence of 1–3 per 1000 live births. The Ponseti method is widely accepted and practiced, giving reliably good long-term results. There are a number of studies showing the benefits of a physiotherapy led Ponseti service with outcomes similar to a consultant led service. We present the first prospective randomised series comparing a physiotherapy led Ponseti service with a standard orthopaedic surgeon led series.

16 infants with bilateral CTEV were randomised into two groups. Each infant had one foot treated by a physiotherapist and the other foot treated by an orthopaedic surgeon using the Ponseti technique. Both groups had a premanipulation Pirani score of 5.5. All patients were followed up for a minimum of 12 months and the results demonstrated no significant difference in the post-treatment Pirani scores (p=0.77) and no significant difference in the success rate the Ponseti technique (p=1.00).

This study is the first of its kind and demonstrates the value of a physiotherapy led Ponseti service in the management of CTEV. Although overall supervision by a paediatric orthopaedic surgeon is still necessary, this service will allow the surgeon to spend more time dealing with more complex problems.

Objective: To analyse the incidence and gravity of reported complications that arise in spinal surgery and assess the comparative safety, or otherwise, of Endoscopic Laser Foraminoplasty.

Methods: The Spinal Foundation, Rochdale, has performed 958 Endoscopic Laser Foraminoplasty procedures and holds a comprehensive database of the results of all operations carried out in this manner. The records of these procedures provided the basis for a comparison of the safety of Endoscopic Laser Foraminoplasty to that found for other spinal surgical techniques as reported in the literature.

Nine hundred and fifty eight procedures have been performed on 716 patients. Complications that arose during the operation and the postoperative phase of six weeks following the procedure were elicited from patient records. This data was correlated and compared to a meta-analysis of randomised controlled trial data available on complications arising during and after conventional spinal surgery. The ‘SPSS’ and ‘CIA’ statistical packages were used to draw conclusions as to the safety of endoscopically assisted laser spinal surgery.

Results: The cohort integrity of operative and review records at six weeks after surgery was 100%. In 958 ELFs performed, 24 complications occurred in 23 patients. There were nine cases of discitis (one infective) (0.9%), one dural tear (0.1%), one deep wound infection (0.1%), two patients suffered a foot drop (one transient) (0.2%), one myocardial infarction (0.1%), one erectile dysfunction (0.1%) and one patient who developed panic attacks post-operatively (0.1%). This amounts to an overall surgical complication rate of 1.6%.

MRI follow up of clinically symptomatic patients highlighted eight residual disc herniations (0.8%).

Meta analysis of randomised controlled trials of conventional spinal surgery for adult onset degenerative disc disease and/or sciatic pain reported overall complication rates for fusion (11.8%), decompression (7.6%), discectomy (6.0%) and chemonucleolysis (9.6%).

Conclusions: The complication rate of Endoscopic Laser Foraminoplasty is shown to be significantly lower than that reported following conventional spinal surgery (P < 0.01). From these results it must therefore be concluded that ELF as a treatment for chronic low back pain and sciatica presents less risk to a patient than conventional methods of spinal surgery.