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Osteochondromas are one of the commonest benign bone tumours, but are rarely found in the spine. Cord compression due to these lesions is even rarer. We describe a case of a C2 lamina osteochondroma causing cord compression in a 20 year old patient who presented with progressive myelopathy. We report on the technical aspects of the operation which resulted in a good decompression and complete excision. Post-operatively the patient made an uncomplicated recovery. We recommend spinal cord monitoring as routine for such procedures. However, whether or not fusion is necessary following a C2 laminectomy is unclear. Given the unique nature of the atlantoaxial joint, we elected to do this, but the literature is uncertain on the biomechanical aspects of this subject. Biomechanical data exists on single and multi-level subaxial laminectomies, but we argue that dedicated studies into post C2 laminectomy biomechanics should be undertaken.

The case notes and court reports of 1, 000 consecutive outpatient referrals to a regional forensic outpatient service were studied retrospectively. Socio-demo-graphic, psychiatric and forensic information was collected. The sample was predominantly male, Caucasian and relatively young in comparison with a general psychiatric population. The commonest source of referral was from defence solicitors and the commonest reason for referral was for a court report. A wide range of diagnoses and offences were noted. A number of differences were found in the frequency of gender, ethnicity and diagnosis according to the source of, and reason for, referral.

There has long been discussion as to the relative merits of the lithium formulations available in the UK. Two of these have been shown to exhibit similar pharmacokinetics in normal volunteers and both are now marketed as controlled release formulations. In this study the serum lithium profiles of these formulations were compared in patients at two centres during the first 4 h after the dose, and at 24 h. We were unable to show any significant difference between the formulations in respect of maximum serum lithium concentrations or the concentration at each time point.

Two factors which affect the creep and stress relaxation of rubbers at room temperature are discussed.

ObjectivesTo identify clinically relevant predictors of progression free survival by retrospectively analysing the anatomical location, pre- and post-operative function and histology in intramedullary spinal cord tumours from a single neurosurgical centre over 10 years.DesignRetrospective review.Methods49 patients were identified from a surgical database. Variables collected included pre-and post-operative Frankel Grade and Modified McCormick Scale assessments, tumour histology, extent of resection and length of follow up. Chi-Squared, Kaplan-Mier Survival and Mann-Whitney U-Tests were completed.ResultsThere was a statistically significant relationship between identification of the tumour plane and extent of resection (p<0.01), along with the extent of resection and recurrence (p<0.01). Compared to the other histological subtypes, ependymoma’s demonstrated a significantly greater extent of resection (p=0.02). There was a significant relationship between the grade of tumour and progression free survival (p<0.01). We did not find a significant relationship between pre- and post-operative neurological function and survival.ConclusionsTumour plane and the extent of tumour resection are significant determinants of progression free survival. Ependymoma, whilst being the commonest histology in our series were also the most resectable. Whilst complete resection reduces the rate of recurrence, tumour grade is the most important predictor of outcome.

ObjectivesTo compare clinical, radiological and complication results between skip laminectomy and cervical laminectomy for posterior cervical decompression for cervical spondylotic myelopathy.DesignRetrospective single institution cohort study.SubjectsSubjects underwent primary skip or cervical laminectomy between 2008–2016.MethodsStatistical analysis compared pre- and post-operative differences in Visual Analogue Scale, Neck Disability Index and radiological differences in sagittal alignment of the vertebral bodies. Analysis of re-operation rates was performed.ResultsA total of 42 and 29 patients had skip and cervical laminectomy respectively. Median follow up was 32±23.1 (Range: 1–325) weeks. Post-operatively there was no difference in patient reported outcomes namely Visual Analogue Scale and Neck Disability Index between skip laminectomy and cervical laminectomy groups compared to pre-operatively (p=0.64, p=0.75). No difference was seen in sagittal alignment between both groups following surgery (p=0.65). Three patients (7.1%) in the skip laminectomy group and two patients (6.9%) in the cervical laminectomy group required revision surgery to the cervical spinal region at a different level to the original surgery. No patients needed further instrumentation.ConclusionsBoth skip laminectomy and cervical laminectomy appear to deliver similar outcomes with regards to patient reported outcomes, preserving sagittal alignment and re-operation rates over this short follow-up period.

ObjectivesTo investigate if there is a significant difference between the LOS for patients admitted as waiting list initiative patients to a private hospital versus standard care in an NHS hospital.DesignRetrospective analysis between 2015 and 2017 of all ACD procedures at the two hospitals.Subjects674 elective NHS patients were included, 340 were admitted to the NHS hospital and 334 as waiting list initiative patients to the private hospital. Acute patients were excluded.MethodsRetrospective database search of electronic hospital records for all ACD procedures carried out between 2015 and 2017. The student standard t test analysis was used to compare the difference in LOS.ResultsIn both groups 100% were admitted on the day of surgery. The mean NHS LOS was 3.3 (SD=6.34) days and the private hospital was 1.1 (SD=0.97) days. (p<0.001) For the patients admitted to the private hospital 96% of the patients went home with 1 night stay, only 61% of the patients went home in the same period in the NHS hospital.ConclusionsWe found that length of stay is significantly shorter in the private hospital than in the NHS hospital. This could be due to patient selection, a swifter patient pathway or a combination of the two and these factors will be explored.

A LABORATORY investigation of the luminescence spectra of a number of materials, of types which might possibly exist on the lunar surface, is being carried out with the view of permitting comparison with the luminescence spectrum of the Moon itself. We excite the luminescence in vacuum by means of a beam of protons1, usually with an energy of about 40 keV, and record the spectrum of any luminescence emission by means of a photoelectric spectrophotometer2.

HARWOOD et al. have recently shown1,2that the phenomenon of stress softening in vulcanized natural rubber containing carbon black as a filler is chiefly associated with changes taking place in the polymer phase—and not, as had previously been supposed, with breakdown of polymer–filler, or filler–filler interactions.