Lumbar spinal stenosis (LSS) is diagnosed by a history of claudication, clinical investigation, cross-sectional area (CSA) of the dural sac on MRI or CT, and walking distance on the treadmill test. As radiological findings do not always correlate with clinical symptoms, additional diagnostic signs are needed. In patients without LSS, we observe the sedimentation of lumbar nerve roots to the dorsal part of the dural sac on supine MRI scans. In patients with LSS, this sedimentation is rarely seen. We named this phenomenon ‘sedimentation sign’ and defined the absence of sedimenting nerve roots as positive sedimentation sign for the diagnosis of LSS. We hypothesised that the new sedimentation sign discriminates between non-specific low back pain (LBP) and LSS. This prospective case-control study included 200 patients in an orthopaedic in- and outpatient clinic. Patients in the LBP group (n=100) had low back pain, a cross-sectional area (CSA) of the dural sac >120mm2, and a walking distance >1000m; patients in the LSS group (n=100) showed claudication, a CSA < 80mm2, and a walking distance < 200m.Hypothesis
Methods and analysis
Although good mid-term results have been reported with some metal on metal hip replacements, reported complications due to metal on metal (MOM) related reactions are a cause for concern. We have assessed the early clinical outcome and results of routine metal artefact reduction MRI findings in a consecutive series of patients with a modern large head metal on metal hip replacement. 62 ASR XL Corail total hip replacements (THR) and 17 ASR resurfacings were performed at our hospital between 2005 and 2008. All patients were reviewed and assessed with an Oxford hip score (OHS), a plain radiograph and a MRI imaging was obtained on 76 (96%) hips. Implant position was assessed using Wrightington cup orientation software.Introduction
Methods
This is the first study to illustrate spinal fracture distribution and the impact of different injury mechanisms on the spinal column during contemporary warfare. A retrospective analysis of Computed Tomography (CT) spinal images entered onto the Centre for Defence Imaging (CDI) database, 2005-2009. Isolated spinous and transverse process fractures were excluded to allow focus on cases with implications for immediate management and prospective disability burden. Fractures were classified by anatomical level and stability with validated systems. Clinical data regarding mechanism of injury and associated non-spinal injuries for each patient were recorded. Statistical analysis was performed using Fisher's Exact test.Introduction
Methods
