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Study Design Randomized controlled trial.Objective The aim of this study was to assess the efficacy of the bone grafting substitute silicate-substituted calcium phosphate (SiCaP) compared with recombinant human bone morphogenetic protein 2 (rhBMP-2) and to evaluate the clinical outcomes over a period of 2 years.Methods Patients undergoing PLF surgery for DDD at a single center were recruited and randomized to one of two groups: SiCaP (n?=?9) or rhBMP-2 (n?=?10). One patient withdrew prior to randomization and another from the rhBMP-2 group after randomization. The radiologic and clinical outcomes were examined and compared. Fusion was assessed at 12 months with computed tomography and plain radiographs. Clinical outcomes were evaluated by recording measures of pain, quality of life, disability, and neurologic status from 6 weeks to 2 years postoperatively.Results In the SiCaP and rhBMP-2 groups, fusion was observed in 9/9 and 8/9 patients, respectively. Pain and disability scores were reduced and quality of life increased in both groups. Leg pain, disability, and satisfaction scores were similar between the groups at each postoperative point; however, back pain was less at 6 weeks and quality of life was higher at 6 months in the SiCaP group than the rhBMP-2 group.Conclusions SiCaP and rhBMP-2 were comparable in terms of achieving successful bone growth and fusion. Both groups achieved similar alleviation of pain and improved quality of life and neurologic, satisfaction, and return to work outcomes following PLF surgery.

Introduction Despite the worldwide increase in the incidence of gunshot injuries, there are few large published series on craniocerebral gunshot injuries in children. Materials and methods The records of 30 consecutive children who were treated for craniocerebral gunshot injuries at the Red Cross War Memorial Children's Hospital from 1989 to 2002 were reviewed retrospectively. The circumstances of the injury, clinical status, CT findings, complications, and outcome were assessed. Results The median age was 7 years. Seventy-seven percent of the victims were boys. The majority of the children were injured in the crossfire of civilian violence. The initial management consisted of debridement under local anesthesia in 16 children and neurosurgical procedures under general anesthesia were performed in 14. Sixteen children sustained transhemispheric injuries, 5 bihemispheric injuries, 5 tangential injuries, and 4 transventricular injuries. All 3 children with a GCS <4 died within 72 h of admission. Three of the 7 children with GCS 4–7 died but there were no deaths in those children whose GCS was >7 post-resuscitation. Motor deficits, cranial nerve palsies, and visual field defects were very common. Early post-traumatic seizures were the commonest complication (18%). Conclusion Children with higher post-resuscitation GCSs fared better than adults in terms of mortality but not necessarily morbidity. As in the case with adults, the GCS after resuscitation is a very good prognostic indicator of mortality.

Introduction Studies that implicate disc infection in the majority of patients with axial back/neck pain or leg/arm pain is potentially scandalous and irresponsible. The majority of these studies are underpowered and lack a contaminant arm, the current study is aimed to fulfil these basic criteria.Material and Methods A prospective case–control multicentric study (HREC 13/218) including cases discectomy for degenerative disc pathology and controls are patients undergoing discectomy for nondegenerate pathology. True disc positivity was inferred if the culture of disc was positive and the paraspinal tissue sample was negative. A total of 400 patients have been enrolled. In degenerative disc cases, 8.7% were true positive (disc +ve/paraspinal −ve) with paraspinal-positive samples in 38.4% on its own. In control cases there was 40% positive for disc culture together with paraspinal tissue. The organisms in disc or paraspinal culture were very similar with 85% having same organisms. On generalized linear model analysis of disc-culture positivity using binomial sets there were no statistical significant findings when comparing disc positivity to demography, type of surgery, modic changes or level of surgery.Conclusions (1) The true rate of disc culture positivity in the degenerative disc population is significantly lower than previous literature reports. (2) At the interim analysis stage, the DISC study heavily favors performing disc cultures strictly with a contaminant control.