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In a substantial proportion of patients with lumbar radicular pain caused by contained disc herniations, lumbar transforaminal injection of corticosteroids is effective in reducing pain, restoring function, reducing the need for other health care, and avoiding surgery. The evidence supporting this conclusion was revealed by comprehensive review of all published data and found to be much more compelling than it would have been if the literature review had been of the limited scope of a traditional "systematic review" of randomized, controlled trials only.

Objectives To compare the outcome of two methods of maternity care during the antenatal period and at delivery. One was to be midwife‐led for both antenatal care and delivery, the latter taking place in rooms similar to those in one's own home to simulate home confinement. The other would be consultant‐led with the mothers labouring in the delivery suite rooms with resuscitation equipment for both mother and baby in evidence, monitors present and a delivery bed on which both anaesthetic and obstetric procedures could be easily and safely carried out. Design Randomised controlled trial. Setting Leicester Royal Infirmary Maternity Hospital. Subjects Of 3510 women who were randomised, 2304 were assigned to the midwife‐led scheme and 1206 were assigned to the consultant‐led scheme. Main outcome measures Complications in the antenatal, intrapartum and postpartum periods were compared as was maternal morbidity and fetal mortality and morbidity. Satisfaction of the women with care over different periods of the pregnancy and birth were assessed. Results There were few significant differences in antepartum, intrapartum and postpartum events between the two groups. There was no difference in the percentage of mothers and babies discharged home alive and well. Generally higher levels of satisfaction with care antenatally and during labour and delivery were shown in those women allocated to midwife care.

Objective.  The objective of this study was to determine the effectiveness of cervical medial branch radiofrequency neurotomy (RFN) performed by two practitioners trained according to rigorous guidelines. Design.  The study was designed as a prospective, outcome study of consecutive patients with chronic neck pain treated in a community setting. Interventions.  A total of 104 patients, selected on the basis of complete relief of pain following controlled, diagnostic, medial branch blocks, were treated with RFN according to the guidelines of the International Spine Intervention Society. Outcome Measures.  Successful outcome was defined as complete relief of pain, or at least 80% relief, for at least 6 months, with complete restoration of activities of daily living, no need for any further health care, and return to work. Patients who failed to meet any of these criteria were deemed to have failed treatment. Results.  In the two practices, 74% and 61% of patients achieved a successful outcome. Relief lasted 17–20 months from the first RFN, and 15 months for repeat treatments. Allowing for repeat treatment, patients maintained relief for a median duration of 20–26 months, with some 60% still having relief at follow‐up. Conclusion.  Cervical RFN can be very effective when performed in a rigorous manner in appropriately selected patients. Chronic neck pain, mediated by the cervical medial branches, can be temporarily, but completely, relieved and patients fully restored to desired activities of daily living, if treated with RFN.