To assess how effective are the prognostic scores and the role of delayed presentation in predicting the outcomes in patients with metastatic spine disease.

Retrospectively data collected from December 2006 to December 2009. Medical records review included types of tumours, duration of symptoms, duration from referral to definitive treatment, expected survival, functional status before and after treatment. Karnofsky performance score and Modified Tokuhashi were used.

Results: 50 patients underwent surgical stabilisation for metastatic spine disease with or with out cord compression. Age ranged from 39 to 87 years (Avg: 64). Patients had four main types of tumours; (Myeloma 30%, Lymphoma 22% Lung CA 16% and Renal 12 %).

Inpatients without cord compression, the average time from referral to definitive treatment is 17 days. Over all fictional status improved in 70% of cases following surgical intervention. Patients who presented with cord compression had surgery with in 49 hours. Patients with high prognostic scores did not survive as long as expected. On the contrary, patients with poor prognostic scores survived longer than expected. This discrepancy is significant in patients with lung and renal malignancies. Patients with Myeloma did well as per the prognostic scores.

Prognostic scores are not uniformly effective in all types of malignancies. Factors like delayed presentation and general condition were not included in the prognostic factors. Hence, we conclude that we cannot make a decision purely based on the prognostic scores to perform either palliative or definitive surgery.

Aim: This study aims to quantify pain relief and quality-of-life benefit from a diagnostic SIJ injection.

Methods: 50 consecutive patients were retrospectively recruited with unilateral low back pain, pain mapping compatible with a sacroiliac origin, tenderness over the SIJ, and no obvious source of pain in the lumbar spine. These were selected for a diagnostic SIJ injection. A structured questionnaire was completed both pre- and post-injection. Median patient age was 63. All patients were injected under fluoroscopic imaging with Triamcinolone 40mgs and 3mls Ropivacaine hydrochloride.

Results: Onset of lower back pain symptoms ranged from 1962 to 2007. 38 patients (76%) had some form of previous non-operative treatment. No patients had previous injection or surgery. 8 patients (16%) were smokers. 17 patients (34%) had a desk based job, 22 patients (44%) had a manual job, 7 patients (14%) had heavy manual jobs. 18 patients (36%) had sustained previous back injury. A visual assessment score was carried out for low back pain and pain in both legs, both pre- and post-injection. Overall, 16 patients (32%) reported no change in their symptoms, 7 (14%) reported worsening, but in 27 (54%) improvement was recorded. When considering the Oswestry Disability Index score, 18% reported no symptom change, 24% worsened and 58% improved.

Conclusion: History and physical examination can enter SIJ syndrome into the differential diagnosis, but cannot make a definitive diagnosis. Fluoroscopically guided diagnostic SIJ injection is the gold standard test for making the diagnosis whilst also conferring substantial pain relieve and quality-of-life benefit.

Conflicts of Interest: None

Source of Funding: None

We would like to present a rare case report describing a case in which new-onset tonic-clonic seizures occurred following an unintentional durotomy during lumbar discectomy and decompression. Unintentional durotomy is a frequent complication of spinal surgical procedures, with a rate as high as 17%. To our knowledge a case of new onset epilepsy has never been reported in the literature. Although dural rupture during surgery and CSF hypovolemia are thought to be the main contributing factors, one can postulate on the effects of anti-psychiatirc medication with epileptogenic properties. Amisulpride and Olanzapine can lower seizure threshold and therefore should be used with caution in patients previously diagnosed with epilepsy. However manufacturers do not state that in cases were the seizure threshold is already lowered by CSF hypotension, new onset epilepsy might be commoner. Finally, strong caution and aggressive post-operative monitoring is advised for patients with CSF hypotension in combination with possible eplieptogenic medication.

Conflict of Interest: None

Source of Funding: None

This is a retrospective review of the results of the Acclaim total elbow replacement in 11 older patients aged ≥ 65 years with primary osteoarthritis of the elbow, with a mean follow-up of 57.6 months (30 to 86.4).

Significant reductions in pain and improvement in range of movement and function were recorded. Radiological review revealed two patients with 1 mm lucencies in a single zone, and one patient with 1 mm lucencies in two zones. No components required revision. There were no deep infections, dislocations or mechanical failures. Complications included one intra-operative medial condylar fracture and one post-operative transient ulnar neuropathy, which resolved.

This study demonstrates that the Acclaim prosthesis provides good symptomatic relief and improvement of function in patients with primary osteoarthritis, with low rates of loosening or other complications. This prosthesis can therefore be considered for patients aged ≥ 65 years with primary osteoarthritis of the elbow.

Introduction: Injury to the wrist may result in derangement of the distal radioulnar joint (DRUJ) and lead to deformity and degenerative changes. This often gives pain on ulnar side of the wrist and limits forearm rotation. We share our experience with the Sauve-Kapandji procedure for chronic posttraumatic derangement of the DRUJ.

Methods: Sixteen patients (seventeen wrists) with chronic posttraumatic derangement of the DRUJ were assessed before and after SauvŽ-Kapandji procedure using Cooneyñs score. There were six men and ten women and average follow up was 64 months.

Results: Mean supination improved from 43.9û to 78.5û and the mean pronation improved from 44.4û to 80.6û at the time of latest follow-up. Pain relief was satisfactory, and the mean grip strength improved from 30.6% of that on the unaffected side preoperatively to 72.1% at the time of follow-up. The ulnar stump was stable in þf-teen patients. Thirteen of the sixteen patients were able to return to work full-time without restrictions. At a mean of 64 months four patients had an excellent result; six a good result; þve a fair result; and one patient a poor result.

Conclusion: On the basis of our þndings, we believe that the index operation is a good salvage procedure for the treatment of chronic posttraumatic derangement of DRUJ, especially when non-operative treatment has been unsuccessful and rotation of the forearm is severely limited.

Aim: The purpose of this study is to investigate the outcomes of bone conserving hip replacements: the Thrust Plate Prosthesis (TPP) and Buechel Pappas (BP) Resurfacing. Method:We have performed total hip replacements in 2 consecutive groups of young patients with osteoarthritis of the hips. In group 1 (TPP group) consists of 103 hips with the thrust plate prosthesis, HA coating and metal on metal bearings (1995~2000). The group 2 (BP group) consists of 25 hips with Buechel Pappas resurfacing with a thin polyethylene liner, ethylene oxide sterilized, and a nitrided titanium bearing surface (1989~1994). The outcomes were evaluated by complication rates, survival, standardized X-rays, a self-assessment satisfaction score, a Harris Hip Score and a Merle dñAubigne score. Results: In group 1, one hip had revision due to infection, and one following traumatic intertrochanteric fracture. No osteolysis and gross migration is seen In group 2, 17 of 25 hips had revision due to osteolysis or femoral neck fracture (mean 4y10m). Conclusion: The Thrust Plate Prosthesis has good outcome at 1 to 6 years follow-up. Buechel pappas resurfacing replacement had poor outcome and almost all cases had osteolysis, which are thought to be due to polyethylene particles.

This study was designed to identify the radiological changes of the knee that correlated with an unfavorable outcome when treated with an intra-articular knee viscoelastic supplementation. A prospective cohort of 60 patients receiving a standard course of intra-articular knee viscoelastic supplementation with a commercial uncrosslinked hyaluronic acid derivative of an intermediate molecular weight were studied.

Follow-up was for 12 weeks post treatment with clinical improvement measured using the Western Ontario and McMasters Universities Osteoarthritis Index. Radiographs of the relevant knee were viewed and graded for the severity of joint space, osteophyte, tibial spine, sclerosis, cyst formation, alignment and general severity by an observer blinded to the outcome of the treatment.

There were no appreciable differences noted in the age, sex, length of follow up, prior treatment, the severity of symptoms before treatment and number of intra-articular injections given per course in each radiographic category identified. There was a significant amount of improvement in patients with a minor loss of medial and lateral joint space in all outcome measures. Minimal changes in tibial spine and global appearance also indicated a positive outcome in stiffness, pain and overall improvement. Thus, patients with moderate to severe osteoarthritic changes in joint space on radiographic examination would not significantly benefit from intra-articular knee viscoelastic supplementation. In addition, we feel that changes in the tibial spine and global appearance are not reviewed consistently enough to be included as part of our recommendation. As such, we conclude that only patients with a minimal to mild loss in joint space on radiological examination should form part of the target group who are likely to benefit from intra-articular knee viscoelastic supplementation.