To evaluate the clinical and cost-effectiveness of a physical and psychological group intervention (BOOST programme) compared to physiotherapy assessment and advice (best practice advice [BPA]) for older adults with neurogenic claudication (NC) which is a debilitating spinal condition. A randomised controlled trial of 438 participants. The primary outcome was the Oswestry Disability Index (ODI) at 12 months. Data was also collected at 6 months. Other outcomes included Swiss Spinal Stenosis Questionnaire (symptoms), ODI walking item, 6-minute walk test (6MWT) and falls. The analysis was intention-to-treat. We collected the EQ5D and health and social care use to estimate cost-effectiveness. Participants were, on average, 74.9 years old (SD 6.0). There was no significant difference in ODI scores between groups at 12 months (adjusted mean difference (MD): −1.4 [95% Confidence Intervals (CI) −4.03,1.17]), but, at 6 months, ODI scores favoured the BOOST programme (adjusted MD: −3.7 [95% CI −6.27, −1.06]). Symptoms followed a similar pattern. The BOOST programme resulted in greater improvements in walking capacity (6MWT MD 21.7m [95% CI 5.96, 37.38]) and ODI walking item (MD −0.2 [95% CI −0.45, −0.01]) and reduced falls risk (odds ratio 0.6 [95% CI 0.40, 0.98]) compared to BPA at 12 months. Probability that the BOOST programme is cost-effective ranged from 67%–89% across cost-effectiveness thresholds.Purpose and background
Methods and results
The spread of upright MRi scanning is a relatively new development in the UK. However, there is a lack of information about whether weight bearing scans confer any additional useful information for low back conditions. Forty-five patient referrals to the upright MRI Department at the AECC for weight bearing lumbar spine scans between November 1st 2014 and June 30th 2015, and the resulting radiologists' reports were reviewed. Age, gender, clinical history, summary of findings, type of weight bearing scanning performed (sitting, standing, flexion, extension) were abstracted. All patients were scanned in a 0.5T Paramed MRopen scanner and all also received supine lumbar spine sagittal and axial scans. The patients comprised 18 females and 27 males, mean age 52 years, (SD 15.5). Thirty had leg pain, 6 of which was bilateral. In 15, a stenotic lesion was suspected. Other reasons for referral were; possible malignancy (1), effects of degenerative change (4), spondylolisthesis (2), fracture, (1), previous surgery (3), trauma (1), sacroiliitis (1) and instability (3). In 12/45 cases, reportable findings were more prominent, and sometimes only identifiable, on weight bearing scans, while in a further 4, the reverse was true. All but one of these involved disruption of the spinal or root canals. Eight of them also involved positional alignment.Purpose and Background:
Methods and Results:
Surgical treatment options for osteoarthritis of the first MTPJ include fusion, excision arthroplasty, interposition arthroplasty and replacement arthroplasty. 1 Arthroplasty of the first MTPJ is not a treatment modality that is, as yet, widely accepted. 2,3 although early results are promising. The Toefit-plus (tm) first MTP joint arthroplasty is an uncemented modular hemi or total joint replacement. The aim of this study was to look at the short to medium term outcome of the Toefit-plus(tm) system, performed by a single surgeon in a district general hospital. This was a retrospective study. Information was obtained from a combination of theatre logs and the operating surgeon's records. Any patient who had undergone Toefit -plus(tm) first MTP joint replacement was included. The demographic information was collated and the patients were scored using the AOFAS-IP scoring system and a VAS for pain.Introduction
Methods
The ITS volar radial plate (Implant Technology Systems, Graz/Austria) is a fixation device that allows for the distal locking screws to be fixed at variable angles (70°-110°). This occurs by the different material properties, with the screws (titanium alloy) cutting a thread through the plate holes (titanium). We present our experience with the ITS plate. We retrospectively studied 26 patients who underwent ITS plate fixation for unstable multifragmentary distal radial fractures (AO types A3, B2, B3, C2, C3). The surgery was performed either by a consultant orthopaedic hand surgeon or senior registrar. A volar approach was used every time and 10 cases required synthetic bone grafting. Post-operatively they were immobilised for an average of 2.5 weeks. The 26 patients had a mean age of 58 and the dominant side was affected in 46% of cases. 5 cases were open fractures and 10 cases followed failed manipulation under general anaesthesia. The average interval between injury and surgery was 7 days. Union was achieved in all cases. No implant infections, failure or tendon rupture/irritation occurred. There were two fractures which loss reduction, of which one required revision surgery. There was one case of CRPS. The six month average DASH score was 27.5. We consider the ITS plate a technically easy plate to use and a reliable implant at early follow-up. We value the versatility of its variable angle screw fixation ability for complex intra-articular distal radial fractures.
Fractures of the distal humeral articular surface which do not involve the medial and lateral columns are often more extensive than is apparent from plain radiographs. This retrospective study describes the epidemiology of this injury using modern classification systems and compares pre-operative radiography with operative findings. The study group included 79 patients with a mean age of 47 years (13 to 91). The annual incidence was 1.5 per 100 000 population, and was highest in women over the age of 60. The majority of the fractures (59; 75%) were sustained in falls from standing height. Young males tended to sustain more high-energy injuries with more complex fracture patterns. In 24% of cases (19) there was a concomitant radial head fracture. Classification from plain radiographs often underestimates the true extent of the injury and computed tomography may be of benefit in pre-operative planning, especially in those over 60 years of age.
Four male patients aged 33, 44, 45 and 52 years, who had undergone different spinal stabilisation procedures consisting of flexible stabilisation (DNESYS), posterior instrumented fusion, and anterior interbody fusion with facet fixation were investigated. Images were acquired and analysed in the same way except that a larger number of images (500 per screening) was utilised in each case. Four operated levels and 2 adjacent levels were analysed. All motion patterns were easily distinguishable from those of the normal subjects. The PLIF and DYNESYS stabilisations demonstrated no motion at the instrumented levels. The anterior inter-body fusion-transfacet fixation patient was shown to have developed a pseudarthrosis.
Registration of the images of each vertebra by templates which are automatically tracked and whose output is converted to inter-vertebral kinematic parameters and averaged for display and reporting. Results are currently displayed as inter-vertebral angles throughout the motion that indicate whether or not solid fusion has been achieved. The Instrument Measurement Error is quantifiable and will vary with image quality, but can be improved by averaging. The technology is applicable to any imaging system of sufficient speed and resolution and may, for example, be used with MR in the future.
This study compared the effect of manipulation with a period of normal activity on the range of intervertebral sidebending. Thirty asymptomatic male volunteers were randomised to treatment or control groups. All were subjected to low-dose X-ray screening through 80° of passive lumbar spine side-bending. Motion sequences were digitised at a 5Hz sampling rate. The treatment group (n=16) had rotary manipulation to each lumbar linkage, followed by normal activity. The control group (n=14) had normal activity only. Both groups were then re-screened. Each vertebral pair was tracked and intervertebral rotation throughout the motion measured. Three subjects were analysed 10 times for reliability and all intervertebral motion was tracked twice. Twenty-one manipulated linkages and 10 controls met the reliability criteria. For non-manipulated segments the mean range at first screening was 14.2° (SD 1.39) and manipulated segments 12.8° (SD 3.81). The range of the non-manipulated segments increased by +0.9o and the manipulated segments by +0.4°. The change in manipulated segments was negligible and similar to controls, although the instrument can be sufficiently reliable to measure a 2° difference. The technique is sufficiently robust to determine if spinal manipulation changes these ranges in selected patients.
