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Lockdown measures to combat the COVID-19 pandemic restricted social interactions and travel. This retrospective, observational study was conducted to evaluate the effect of lockdown restrictions on Oswestry Disability Index (ODI) scores in patients with spinal conditions.Prospectively collected data from the British Spine Registry were retrospectively analysed in two groups. The study group included patients' baseline pre-operative ODI scores collected during the first national lockdown in the UK between March and May 2020. The reference group included ODI scores recorded during the same period in 2019, before the pandemic. Scores were compared between groups using the Mann-Whitney U test. We also calculated modified scores that omitted responses to questions related to travel and social life. These were compared using Wilcoxon matched-pairs signed-rank test and Bland-Altman analyses.The median ODI scores for the reference and lockdown groups were 49 and 45, respectively, with no significant differences in the mean ranks (p = 0.068). Comparisons of original and modified ODI scores showed different outcomes for each study group. No significant differences were observed in the lockdown group (p = 0.06). However, for the pre-COVID-19 reference group, there was a significant difference (p 0.01). Bland-Altman analyses showed reasonable agreement between the methods for calculating ODI in both groups.We found no clinically important differences in ODI scores between the two groups. The findings suggest that the ODI is reliable during lockdown situations and can be used with confidence in the future research using both retrospective and prospective data.Level 3.

Background/Aims Documentation is key for communicating between members of the multidisciplinary team, allowing for better care, but documentation for spinal patients in the authors' centre was poor. Methods Every ward round encounter was analysed for six weekends. Data were analysed and presented to the department. A weekend ward round proforma was designed to help improve ward-round documentation. Ward round entries were then re-audited over four weekends to assess the usefulness of the new proforma. Results A total of 69 patient encounters were analysed in cycle 1, 58 in cycle 2 and 92 in cycle 3. In cycle 1, 80% of encounters had inadequate documentation. Following introduction of the ward round proforma there was a significant improvement in documentation in six out of fields, which was maintained in four out of seven fields 2 years later. Conclusions The authors believe that this improvement may avoid adverse effects on patient care, streamline doctors' time and reduce medicolegal consequences.

Introduction The purpose of this study was to analyse SRS-22 outcomes measures recorded on the British Spine Registry (BSR) for adolescent idiopathic scoliosis (AIS) surgery in the UK. Methods All cases having completed an SRS-22 outcome score and labelled with a diagnosis code of ‘AIS’ on the BSR were analysed. The SRS-22 score for primary cases was analysed by both individual domains and as a total score over time following surgery. Results A total of 3,860 cases were labelled as AIS recorded from 3,481 individuals. For primary cases, surgery improved the SRS-22 scores in every domain and as a total score, and this was maintained over time. There was no significant change in the scores recorded between 1 and 2 years of follow up apart from in function (and thus total score) for primary cases. Conclusions Surgery for AIS in the UK improves quality of life assessed using SRS-22. Mandatory follow up to 2 years postoperatively adds little information not already known at 1 year. We recommend that the Best Practice Tariff incorporates the collection of outcomes data as this is likely to reduce missing data.

There is an increasing body of research suggesting that low body weight is associated with scoliosis, but this is based on case-control studies, which are prone to bias. No studies have investigated the components of body weight: fat and lean mass. We have therefore carried out the first population-based prospective study of the association between fat and lean mass at age 10 years assessed by dual-energy X-ray absorptiometry (DXA), with presence of scoliosis at age 15 years using the Avon Longitudinal Study of Parents and Children (ALSPAC). All children with scoliosis at age 10 years were excluded. Of 5299 children at age 15 years, 312 (5.9%) had scoliosis. Our results show a negative association between body mass index (BMI)/body weight at age 10 years and scoliosis at age 15 years, with a 20% reduced risk of scoliosis per SD increase in BMI (odds ratio [OR], 0.80; 95% confidence interval [CI], 0.70–0.92; p = 0.001). This association with BMI/body weight reflects associations with both fat mass and lean mass. After adjustment for age, gender, leg length, and fat mass per SD increase in lean mass, there was a 20% reduced risk of scoliosis (OR, 0.80; 95% CI, 0.65–0.97) and per SD increase in fat mass there was a 13% reduced risk of scoliosis (OR, 0.87; 95% CI, 0.74–1.03). In terms of adipocyte function, an inverse association was seen between leptin at age 10 years and scoliosis (OR for scoliosis per SD increase in leptin of 0.78; 95% CI, 0.63–0.99), and a positive association between adiponectin at age 10 years and scoliosis (OR for scoliosis per SD increase in adiponectin of 1.44; 95% CI, 0.99–2.10). This is the first study to address the association between the individual components of body weight and scoliosis in a prospective cohort study, and shows altered body composition that is present before the onset of clinically detected scoliosis. © 2014 American Society for Bone and Mineral Research.

Background: Studies concerning adult patients with spastic flexion contracture of the knee are rare. Such patients frequently have cutaneous and vascular complications as well as recurrence of the contracture after treatment. We present a strategy consisting of simultaneous correction of all deformities of both lower limbs, distal hamstring releases, and application of femorotibial external fixation when extension of the knee is limited by excessive posterior soft-tissue tension. Methods: A consecutive series of fifty-nine patients (ninety-seven knees) between the ages of twenty-one and seventy-seven years received surgical treatment for a flexion contracture of the knee secondary to neurological impairment. The flexion contracture was bilateral in thirty-eight patients. Preoperatively, the mean flexion contracture angle was 69° and the mean passive range of motion was 61°. The contracture was corrected, through medial and lateral approaches, with distal hamstring lengthening. A posterior capsulotomy was performed in thirty-five knees. Full extension of thirty-four knees was achieved intraoperatively. In seventy-seven knees, partial correction was maintained with a unilateral external fixator, and passive and active mobilization was performed four times daily after temporary removal of the spanning external fixator rod. Results: At the time of final follow-up, ranging from one to five years postoperatively, the mean residual flexion contracture was 6.2°. Forty-five knees had complete extension, and thirty-nine knees had a residual flexion contracture of

We report the outcome of humeral head surface replacement hemiarthroplasty performed at our institution using the Copeland prosthesis. We followed 56 shoulders (52 patients) for a mean of 34.2 months (range, 24-63 months). Two were lost to follow-up, and there were six deaths unrelated to the shoulder surgery. Preoperative diagnoses in the remainder were osteoarthritis (20), rheumatoid arthritis (26), rotator cuff tear arthropathy (1), and post-traumatic arthrosis (1). The mean age was 68 years. Constant scores for the whole group improved from a mean preoperative score of 16.4 (range, 8-36) to 54.0 (range, 20-83) at last follow-up (P.05). Three cases underwent subsequent arthroscopic subacromial decompression for impingement symptoms. One case required revision for aseptic loosening to a stemmed implant. Contained, nonprogressive osteolysis was seen in 2 cases. One periprosthetic humeral neck fracture was managed successfully nonoperatively. These results are comparable to those obtained with a modern stemmed hemiarthroplasty and are similar to Copeland's own series.

STUDY DESIGN: A retrospective analysis of patients with idiopathic scoliosis treated with Schollner costoplasty. OBJECTIVE: To evaluate the long-term effects of Schollner costoplasty on rib hump and respiratory function SUMMARY BACKGROUND DATA: Costoplasty is an established technique to improve chest wall deformity in patients with scoliosis. Concerns have been raised of the long-term effects of costoplasty on respiratory function in adults. No long-term studies of this procedure exist. METHODS: A total of 25 patients with idiopathic scoliosis rib hump deformity underwent Schollner costoplasty. There were 12 patients who underwent surgery on the convexity alone, and 13 underwent additional "concave surgery" (6 Silastic [Dow Corning Corp., Midland, MI] implants, 7 concave lengthenings). Five patients underwent simultaneous spinal arthrodesis. The remaining patients underwent delayed procedures (0.4 -19 years) following the index operation. Vital capacity (VC) and rib hump were measured before and after surgery, and at each attendance thereafter. RESULTS: Mean follow-up was 10.8 years. Average reduction in rib hump was 38 mm at 6 months and 29 mm at long-term. There was no significant difference in the preoperative and long-term VC (P = 0.4), although at 6 months after surgery, there was a significant reduction in VC of 5.1%(P = 0.03). Subgroup analysis (convex only, concave lengthening, concave Silastic) revealed a similar pattern for rib hump correction and maintenance of VC in the long-term for each group. There was no significant difference between adults and adolescents in terms of both the reduction in rib hump and the VC (P = 0.2 and 0.3) CONCLUSIONS: Rib hump correction and lung function are preserved in the long-term following Schollner costoplasty in both adults and adolescents.

The efficacy of teicoplanin, a glycopeptide antibiotic, in endocarditis is controversial, with differences observed in the efficacies of the regimens used in clinical trials in the USA and Europe. This retrospective study examined the outcomes, efficacy and safety of mono- and combination antibiotic therapy using teicoplanin, particularly in cases of Staphylococcus aureus endocarditis. A total of 115 patients, typically mixed endocarditis patients intolerant of previous antibiotic treatment, was enrolled at 29 centres throughout Europe. Combination therapy was more successful than monotherapy for treating native valve endocarditis (NVE) (93 vs. 85%, p > 0.05, NS) and for treating S. aureus NVE (84 vs. 50%, p > 0.05). Efficacies for prosthetic valve endocarditis (PVE) were similar (75 vs. 79%), while combination therapy was more successful in S. aureus PVE (100 vs. 67%) though the number of such patients was small (NS). Adverse events were reported by 24% of patients, with 19% probably or possibly related to teicoplanin. In 9% of cases the adverse event led to the termination of therapy. Teicoplanin was judged to be efficacious in mono- or combination therapy in streptococcal endocarditis, though augmentation with an aminoglycoside is recommended. The efficacy of teicoplanin demonstrated in enterococcal endocarditis represents a major therapeutic advance.

PURPOSE: To evaluate the efficacy and utility of SPECT/CT as a diagnostic modality and preoperative planning tool in patients undergoing fusion surgery for low back pain and/or leg pain. STUDY DESIGN/SETTING: A prospective cohort study (n525) performed over a 2-year period. PATIENT SAMPLE: All consecutive patients requiring lumbar spondylodesis for back pain and/or leg pain included. OUTCOME MEASURES: Clinical outcome measures included EQ-5D, EQ-5D VAS, ODI and VAS Pain Scores. METHODS: SPECT/CT fusion imaging was performed in conjunction with standard CT and MRI preoperatively to guide patient selection and surgical planning. Clinical outcome measures were collected preoperatively and at 6 weeks, 6 months and 1 year postoperatively. RESULTS: SPECT/CT fusion imaging demonstrated increased sensitivity for facet degeneration when compared to MRI. No difference was identified when comparing SPECT/CT to standard CT to assess disc degeneration. There was a significant improvement in all clinical outcome measures assessed preoperatively and followed out to 1-year postoperatively. Mean ODI score improved from 58.92 to 12.0; VAS back pain score improved from 7.46 preoperatively to 1.0; VAS leg pain score improved from 4.15 to 0.25. CONCLUSIONS: SPECT/CT fusion imaging is an excellent adjunct to existing imaging modalities, facilitating accurate level selection in patients undergoing lumbar fusion surgery for low back pain and/or leg pain. Lumbar fusion surgery guided by SPECT/CT fusion imaging was associated with excellent postoperative health related quality of life (HRQOL) outcome measures. CONFLICTS OF INTEREST: None. FUNDING SOURCES: None.

Twenty-five published clinical studies were reviewed in which teicoplanin serum concentrations were determined. A variety of assay methods were used, including bioassay, solid phase enzyme receptor assay, HPLC and immunoassay, and in some studies, more than 1 methodology was used. Fourteen studies gave sufficient data on the method of assay, timing of assays relative to dosage or during therapy, and route of administration of teicoplanin to be included in a detailed pharmacokinetic analysis. Since a wide range of dosing regimens were employed, the studies were grouped in order to facilitate analysis according to the teicoplanin maintenance dose, either 200mg, 400mg or 6mg/kg/day. Six studies used a dose of 200mg/day and although the mean trough concentrations varied by as much as 3-fold, they did not exceed 10mg/L in the first 7 days of therapy. Six studies used a 400mg/day maintenance dose and the mean trough concentrations varied from 4 to 11mg/L on days 1-2, to 9 to 17mg/L on days 6-7 of therapy. In 5 of these studies, the mean trough concentration was less than 10mg/L for the first 48 hours of treatment. In 2 studies where a dose of 6mg/kg/day was used, the mean concentrations did not exceed 10mg/L until day 7, while in the other study they were greater than 10mg/L beginning on day 1. A retrospective analysis of 58 clinical cases reported in the literature, 42 of whom had staphylococcal infections, indicated that serum concentrations and teicoplanin concentration/MIC ratios were related to clinical cure particularly for patients with staphylococcal infections. Trough concentrations of greater than 10mg/L were related to favorable outcomes when all 58 patients were analyzed and trough concentrations of greater than 20mg/L were related to cure for those who had staphylococcal infections. While retrospective in nature, this review indicates that there is considerable variation in teicoplanin pharmacokinetics in the different patient groups, only some of which is related to differences in dosing, timing of blood collection for assay or assay methodology. In addition, these data suggest that pharmacokinetic parameters such as trough and postdose teicoplanin concentrations, and phamracodynamic factors such as serum concentration MIC ratios may be related to clinical outcome with teicoplanin therapy.

A total of 88 patients were treated with teicoplanin for infections caused by coagulase-negative staphylococci in open clinical studies in France and the UK. Teicoplanin was administered once daily, with a mean dose of 323 mg, for a mean duration of 16 days. Thirty-nine patients received teicoplanin alone while 49 received combination treatment. Clinical cure or improvement occurred in 79 of 82 evaluable cases (96.3%) and bacteriological elimination in 82 cases (95.1%). Treatment with teicoplanin alone was clinically successful in all cases, including 20 septicaemias, and the elimination rate was 93%. There was no apparent correlation between clinical and bacteriological outcomes and results of in-vitro testing. The variation in MICs between France and the UK was attributed to differences in the methods used.

It gives us pleasure to publish extracts from a remarkable unpublished work by an Australian author, Ian Harding. In four chapters (Antiquity, Islam, Some European Developments, Henry Dunant) it covers the origins of the Geneva Conventions from ancient civilizations, and then goes on to explain their significance in international law and action (The Conventions, The Propositions, The Conclusions). The passages we quote below deal with the history of humanitarian ideas and the laborious efforts, repeated time and time again throughout the centuries, for the ever more effective protection of human dignity. (Ed.).

Nous sommes heureux de publier quelques extraits * d'un remarquable ouvrage, encore inédit, d'un auteur australien, M. Ian Harding. Celui-ci étudie, en quatre chapitres (Antiquité, Islam, Quelques développements en Europe, Henry Dunant), les origines des Conventions de Genève depuis les civilisations anciennes, puis ce que représentent ces mêmes Conventions dans la perspective du droit international et sur le plan de l'action (Les Conventions, Propositions, Conclusions). Les passages que nous reproduisons aujourd'huiont trait à l'histoire des idées humanitaires et témoignent du pénible effort, sans cesse repris au long des siècles, pour défendre toujours mieux la dignité humaine. (Réd.)