A B S T R A C TBackground. Spinal intervention procedures are widely practiced. Complications are sometimes described in case reports, but the full spectrum of possible complications has not been comprehensively publicized. The fact that certain complications continue to occur suggests that practitioners may not be fully aware of the nature of possible complications and how to recognize warning signs.Objectives. To highlight the nature of potential complications of spine interventions and to assist practitioners in recognizing warning signs of impending complications so that they might be prevented.Methods. Complications described in the literature and encountered by the authors in medicolegal proceedings were identified. Illustrations of such complications were collated together with illustrations of phenomena that might have led to complications had they not been recognized and the procedure appropriately corrected or abandoned.Results. Infection is a risk common to all invasive procedures. Spinal cord injuries have occurred during cervical medial branch blocks, intra-articular injections, and radiofrequency neurotomy because operators did not obtain correct views of the target region and misdirected their needles or electrodes. Similar errors have occurred in the conduct of lumbar blocks and neurotomy. The complications of lumbar intradiscal procedures include infection, injury to a ventral ramus, and breakage of electrodes. Cervical discography, additionally, can be complicated by spinal cord injury. Cervical transforaminal injections have been complicated by injections into a reinforcing radicular artery or the vertebral artery. Lumbar transforaminal injections have been complicated by intraarterial injections and subdural or intrathecal injections. Epidural injections can be complicated by subdural or intrathecal injections, or venous puncture resulting in a haematoma. Intra-articular injections of the lateral atlantoaxial joint and sacroiliac joint theoretically could be complicated by injury to adjacent vessels, nerves, or viscera.Discussion. Strict adherence to published guidelines provides safeguards against encountering complications. Complications are avoided by operators knowing all the relevant anatomy of the procedure and being able to recognize aberrations in the procedure as soon as they occur.

Objectives: To assess the effect of sulfasalazine (SSZ) on inflammatory back pain (IBP) due to active undifferentiated spondyloarthritis (uSpA) or ankylosing spondylitis in patients with symptom duration ,5 years. Methods: Patients with IBP and a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) .3 from 12 centres were randomly assigned to 24 weeks' treatment with SSZ 2 g/day or placebo. The primary outcome variable was the change in BASDAI over 6 months. Secondary outcomes included measures of spinal pain, physical function and inflammation. Results: 230 patients (50% men, age range 18-64 years, 67% human leucocyte antigen B27 positive) were treated with either SSZ 261 g/day or placebo for 6 months. Enthesitis was found in 50%, and peripheral arthritis in 47% of the patients. The mean (SD) BASDAI dropped markedly in both groups: by 3.7 (2.7) and 3.8 (2.4), respectively, as did most secondary outcome measures. No noticeable difference in treatment was observed between groups. Patients with IBP and no peripheral arthritis had significantly (p = 0.03) more benefit with SSZ (BASDAI 5.1 (1.3) to 2.8 (2.3)) than with placebo (5.2 (1.6) to 3.8 (2.4)). Spinal pain (p = 0.03) and morning stiffness (p = 0.05) improved with SSZ in these patients, but other secondary outcomes were not markedly different. Conclusion: SSZ was no better than placebo for the treatment of the signs and symptoms of uSpA; however, SSZ was more effective than placebo in the subgroup of patients with IBP and no peripheral arthritis.

End-of-life care and planning is critically important to the next decades of health care in Canada. In our country, between 2005 and 2036, the number of seniors 65 years and older is projected to increase by up to 25%, and the number of deaths by 65%. The majority of patients are currently admitted to hospital and intensive care units at the end of life; however, up to 70% of elderly patients say they would prefer a less aggressive treatment plan focusing on providing comfort rather than a technologically supported, institutionalized death. Herein we provide a brief overview of the end-of-life care in the Canadian context, and highlight challenges and opportunities for health care system change in the coming decades.

Using a monospecific rabbit antibody against Yersiniu enterocolitica outer membrane protein 1, we examined synovial biopsy specimens from 7 patients with Yersiniu-induced arthritis. Yersinia were demonstrated in the synovial membrane by indirect immunofluorescence in 4 patients with Yersiniu-induced arthritis, but not in 6 control patients with Salmonella-induced arthritis or with rheumatoid arthritis. These findings suggest the persistence of Yersinia in the joints of patients with Yersinia-induced arthritis.In the past 20 years, enteropathogenic Yersiniu have been identified with increasing frequency as the causative agent of acute bacterial gastroenteritis and extraintestinal complications such as reactive arthritis and erythema nodosum (1-6). Until recently, Yersiniainduced reactive arthritis was diagnosed on the basis of a clinical picture of arthritis following gastroenteritis, and elevated agglutination antibody titers (Widal's reaction) for Yersiniu (1,3,4,6,7). The recent use of immunoblot analysis of class-specific serum antibodies against plasmid-encoded Yersiniu proteins has made