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The findings of an expert panel convened to review critically how best to apply evidence-based guidelines for the treatment of acute pain in the Middle East region are presented. The panel recommended a three-step treatment protocol. Patients with mild-to-moderate levels of acute pain should be treated with paracetamol (step 1). If analgesia is insufficient after 1 -2 days, a selective cyclo-oxygenase-2 inhibitor or, if gastrointestinal safety and bleeding risk are not an issue, a non-specific nonsteroidal anti-inflammatory drug, should be used (step 2). If analgesia remains inadequate, treatment with tramadol, or paracetamol plus codeine/tramadol is recommended (step 3). Patients reporting severe pain should be referred to a pain clinic or specialist for opioid analgesic treatment. Measures of pain and functioning that have been validated in Arabic, with culturally appropriate and easy to understand descriptors, should be used. Early and aggressive acute pain management is important to reduce the risk of pain becoming chronic, especially in the presence of neuropathic features.

Study Design: A retrospective radiographic analysis.Purpose: The aim of the current study is to assess endplate changes after the use of polyetheretherketone (PEEK) cages in posterior lumbar interbody fusion (PLIF).Overview of Literature: A few recent reports had revealed endplate abnormalities due to PEEK cages, which may lead to nonunions.Methods: A retrospective computed tomography (CT)-based analysis of the endplate cavities and fusion status following PLIFs with PEEK cages was conducted by two independent observers. The term “cavity” was used to describe the endplate changes. The vertebral endplate cavities were assessed according to the size, multiplicity, location, and presence or absence of sclerosis.Results: There were 86 fixed levels in 65 consecutive patients, with a mean age of 35.44±19.60 years. The mean follow-up was 16.5±10.1 months (range, 6–57 months). Definite fusion was seen in 56 levels (65.12%) by observer 1 versus 44 levels (51.16) by observer 2. The strength of agreement was moderate. Endplate cavities were observed in 42 levels (48.84%) by observer 1 versus 47 levels (54.65%) by observer 2, with fair agreement. The strengths of agreement for the locations, multiplicity, and size were moderate, fair, and poor, respectively. Neither age, sex, etiology, levels, nor follow-up period was significantly associated with the presence of cavities. With regard to fusions, the nonunions detected by observer 1 were significantly associated with the presence of cavities (p<0.0001). However, those detected by observer 2 were nearly significant (p=0.05).Conclusions: There was a high rate of unfavorable radiographic findings in the form of endplate cavities in PLIF cases with PEEK cages. A more comprehensive classification for the assessment of fusions and endplate cavities should be formulated. We strongly recommend further CT-based studies with larger sample size and longer follow-up periods.

Introduction: Femoroacetabular impingement (FAI) has been suggested as an important etiology of pain in the groin region in young adults especially athletes and there are theories connecting it to early onset osteoarthritis. Aim: To assess the results of arthroscopic treatment of FAI. Patients: Forty patients had been managed arthroscopically for their FAI in both El-Hadra university hospital and William Harvey Hospital. Methods: Results of arthroscopic treatment of FAI in 40 consecutive patients had been evaluated using patients reported outcomes (modified Harris Hip Score and international Hip Outcome Tool-12) and clinical measures of improvement of range of motion in both flexion and internal rotation in 90°of hip flexion. Results: The average of the outcome scores showed statistically significant improvement following the arthroscopic intervention. Conclusion: Femroacetabular impingement is an important etiology of groin pain in young adults, nevertheless the athletes. Diagnosis of this condition is primarily a clinical one to be supported with relevant imaging. Hip arthroscopy is an effective approach to treat and correct the underlying bony abnormalities of FAI. Younger age of patients predicts better improvement in i-HOT-12 score.

Objective: The objective was to compare Cobb angle measurements performed using an Oxford Cobbmeter and digital computer software (Surgimap) in a series of 83 adolescent idiopathic scoliosis (AIS) patients. Methods: Two independent observers measured the Cobb angles for 123 curves on 83 consecutive long radiographs of patients with AIS using both Oxford Cobbmeter and digital computer software (Surgimap). The measurements were repeated a week. Curves were classified according to the severity into mild, moderate, and severe. The results were statistically analyzed for intraobserver and interobserver reliability Results: The mean Cobb angle was 48.12°± 19.75° (range, 10.54°-110.76°). Globally the results of curve measurements were comparable between and within both observers using both methods, with small mean differences. According to intraclass correlation coefficient, there was high inter-and intraobserver high agreement for both methods. All readings were > 0.9. There was a good interobserver (κ = 0.745, 0.693) and a very good interobserver agreement (κ = 0.810, 0.804) for both methods for curve classification. However, poor agreement was observed as regards to the measurement time, being less with Oxford Cobbometer. Conclusion: The results of this study indicate that the Surgimap digital computer software measurement is an equivalent measuring tool to the Oxford Cobbmeter in Cobb angle measurement. Both have high intra and interobserver agreement for measurement and for curve classification, with small measurement differences. Oxford Cobbmeter is advantageous in being quicker, and therefore it is the method of choice for manual measurement, where PACS (patient archiving and communication system) or digital system is not available.