Chronic pain at the donor site was reported by 25% of 290 patients who had undergone anterior lumbar spine fusion for low back pain. Donor site pain has characteristic clinical features, may be severely disabling and is stubbornly resistant to treatment. The highest prevalence was in patients who had a tricortical full thickness graft taken through a separate incision overlying the iliac crest. Patients with a clinically unsatisfactory result from the spine fusion also had a significantly higher prevalence of donor site pain.

Summary Osteomyelitis of lumbar vertebrae was seen in three dogs in association with penetration of grass seeds. In one dog a sinus extended from the sublumbar abscess to the flank. In two dogs there was extensive destruction of two lumbar vertebrae and hind limb weakness. All cases responded to removal of the grass seed and drainage. The possible route of entry of the seed is discussed.

SummaryTwenty Adult traumatic paraplegics with neurologically complete lesions between C8 and T12 have ambulated using a ParaWalker (adult hip guidance orthosis), for a minimum of 6 months at home. At follow up, on average 20 months from the date of issue of the orthosis, 17 patients (85%) were still regularly using their Para Walker. Patients achieved independent use of the orthosis and low energy ambulation both indoors and outdoors on a variety of surfaces.A new classification of adult paraplegic ambulation using an orthosis is de scribed.

This education evaluation indicates that the patients we talked with in the UK counties of Shropshire and Staffordshire overwhelmingly sought doctors with good personal qualities and communication skills. Of the attributes recorded, 92 per cent were related to such qualities, with only 8 per cent emphasising knowledge and intelligence, and with no comments on manual skills. The results support the current emphasis in UK medical schools on communication skills and professionalism, and the development of personal qualities through the promotion of humanities teaching. The modern medical school curriculum highlights the importance of good communication skills.

Shelfoperations performed on 24 patients (27 hips)for late presentation of congenital hip dysplasia were evaluated. The mean age at operation was 14 years 9 months and the mean follow-up 16 years 8 months. Twothirds of the hips had good clinical results at follow-up. Patients operated on under the age of 20 years and with little or no radiological evidence of degenerative joint changes had the highest likelihood of success. The shelf operation was found to provide good cover of the femoral head and, should failure occur, also provides adequate superior support for the seating of an acetabular prosthesis.

No abstract

Acute low back pain associated with significant restriction in SLR is likely to be caused by a disc prolapse compressing the anterior theca.

A personal series of twelve wrist arthroplasties performed on ten patients with rheumatoid arthritis of the radio-carpal joint were reviewed in retrospect. Six arthroplasties were of the Meuli metal/plastic/metal design and six were of the Swanson silastic type with an additional silastic ulnar head prosthesis. Both prostheses were successful in giving a pain free stable joint with some degree of useful movement. The Meuli appeared to give a greater range of movement than the more constrained Swanson prosthesis. Although complications were encountered it is concluded that wrist arthroplasty does have a place in the management of patients with rheumatoid arthritis of the radio-carpal joint. Our present policy is to continue with the use of the Swanson design because of the advantages of a cement free prosthesis.