Lumbar disc disease: the effect of inversion on clinical symptoms and a comparison of the rate of surgery after inversion therapy with the rate of surgery in neurosurgery controls.

[Purpose] We have previously shown inversion therapy to be effective in a small prospective randomised controlled trial of patients with lumbar disc protrusions. Our purpose now was to measure symptoms and to compare the surgery rate following inversion for 85 participants with the surgery rate in 3 control groups. [Participants and Methods] Each of the 85 inverted participants acted as their own control for the "symptomatic" part of the study. In the "Need for surgery" part of the study, one control group was made up of similar patients with leg pain and sciatica who were referred to the same clinic in the same year. Two additional control groups were examined: the original control group from the pilot trial and the lumbar disc surgery waiting list patients. [Results] Inversion therapy relieved symptoms: there were improvements in the Visual Analogue Score, Roland Morris and Oswestry Disease indices and Health Utility Score compared with their pre-treatment status. Also, the 2 year surgery rate in the inversion participants in the registry (21%) was significantly lower than in the matched control group (39% at two years and 43% at four years). It was also lower than the surgery rate in the other 2 control groups. [Conclusion] Inversion therapy relieved symptoms and avoided surgery.

Improving mortality after extradural haematoma in England and Wales.

INTRODUCTION: Head injury is an important cause of death and disability in young people, with 1.4 million presentations each year in the UK.( 1 ) Extradural haematoma (EDH) is a potentially fatal head injury, which is easily remedied surgically. Several factors influence the mortality of EDH. The mortality of isolated EDH ranges from 1.2 to 33%.( 12 , 16 , 19 , 28 ) EDH outcome within the UK has not been recently described. MATERIALS AND METHODS: The Trauma Audit and Research Network (TARN) database was used to collate data on patients in England and Wales, with 'isolated' EDH between 1997 and 2003. Age, gender, GCS at 1(st) emergency department (ED), haematoma size, presence of a skull fracture, outcome (alive or dead) and injury-to-operation time were required. Where this time was unavailable, an estimation could be made using another time collected for the patient. Data coordinators at several hospitals were contacted in order to collect extra information missing from the database. The mortality for this group was then calculated and comparisons between this and previous series were made. RESULTS: A total of four-hundred and eighty four (484) patients with isolated EDH were identified. One-hundred and ninety-seven (197) patients were operated on in England and Wales in this TARN dataset, between 1997 and 2003 for 'isolated' EDH. The mortality rate for this operative series was 2% (4 patients) (95% CI 0.1-4%). The non-operative mortality rate was 3% (95% CI 0.9-5.0%). CONCLUSION: This study has found a low EDH operative mortality rate of 2%. This is lower than that of previous studies on isolated EDH in the UK. This is likely to be valid as TARN is the largest European trauma registry, although we acknowledge that this first EDH sample derived from UK EDs may represent a selected series.

Image-guided drainage of cystic vestibular schwannomata.

The management of vestibular schwannomata is controversial. Surveillance remains an acceptable option for elderly patients or those with small lesions. Stereoradiosurgery is also an option, while surgery is often preferred in younger patients with larger lesions. In elderly patients with lesions causing brainstem compression, craniotomy is a major undertaking. We report two cases of cystic cerebellopontine angle tumours in patients with co-morbidity, who were managed successfully with image-guided insertion of a cystoperitoneal shunt.

Reliability assessment of computerized tomography scanning measurements in intracerebral hematoma.

OBJECT: As one of the aspects of the International Surgical Trial in Intracerebral Haemorrhage (STICH), prerandomization computerized tomography (CT) scans were collected. In the present study the authors determined the inter-and intraobserver variability of various parameters pertinent to CT scans obtained in patients with intracerebral hematomas (ICHs). METHODS: A protocol was devised to analyze CT scans in a uniform and systematic manner. Each observer evaluated the same set of scans twice, with a minimum 2-month interval between assessments. In addition to noting the side and the sites of involvement, the observers measured the scale present on the scan itself and the length, breadth, height, and depth of the spontaneous ICH as well as the midline shift. The intraclass correlation was very high (kappa 0.8-1) for the measurements of volume, depth, and midline shift. Good interobserver agreement (kappa 0.8-1) was demonstrated with regard to involvement of basal ganglia or thalamus, presence of intraventricular extension, and the side of the hematoma. Agreement was substantial (kappa 0.61-0.8) with regard to identifying primary involvement of particular lobes. Agreement was moderate (kappa 0.41-0.6) on the presence or absence of hydrocephalus. When comparing the first and the second sets of readings, the intraobserver agreement was good (80-100%). CONCLUSIONS: The study quantifies the degree of inter- and intraobserver agreement regarding evaluation of CT scans in patients with ICH when conducted in accordance with a set protocol.