IV zoledronic acid is an effective and well-tolerated treatment to prevent bone mineral density loss at the total hip and trochanter for up to 12 months following SCI.

Study design: Single subject pilot. Objectives: (i) To see whether strength and endurance for recreational cycling by functional electrical stimulation (FES) are possible following spinal cord injury (SCI). (ii) To develop the equipment for FES-cycling. Setting: England. Methods: Near-isometric or cycling exercise was performed by the incomplete SCI subject at home. Results: After training for an average of 21 min per day for 16 months, the stimulated muscles increased in size and the subject was able to cycle for 12 km on the level. Surprisingly, there was a substantial increase in the measured voluntary strength of the knee extensors and the subject reports improved leg function. Conclusion: FES-cycling may promote recovery after incomplete spinal cord injury. If so, it o ers the possibility of being a convenient method for widespread use.

The intra-articular injection of local anaesthetic is frequently used for pain relief after arthroscopy. There is, however, no published evidence of the analgesic effect of bupivacaine in the ankle. In a randomised, double-blind study, 35 patients undergoing arthroscopy of the ankle were allocated to receive intra-articular saline or bupivacaine. Pain was assessed using pain scores and additional analgesic requirements. Intra-articular bupivacaine had a significant analgesic effect in the immediate post-operative period, reducing pain scores and the need for additional analgesics. We recommend the use of intra-articular bupivacaine for post-operative analgesia in ankle surgery.

Study design: Investigation of bowel function in 55 patients and 26 healthy volunteers using radiological, anorectal physiological and laser Doppler blood flow monitoring. Objectives: Bowel dysfunction is common after spinal cord injury (SCI). We aimed to determine whether hindgut testing of autonomic innervation provides insight into presence of symptoms, altered motor function (transit) and level of injury. Setting: St Mark's Hospital, UK and The Spinal Injuries Unit, Royal National Orthopaedic Hospital, UK. Methods: A total of 55 patients with chronic complete SCI and 26 healthy volunteers were studied. Twenty-four patients had lesions above T5 and 31 had lesions below T5. Thirty-five patients complained of constipation: 75% (18/24) of patients with lesions above T5 and 55% (17/31) of those with lesions below T5. Gut transit, rectal electrosensitivity and rectal blood flow were measured. Results: Slow gut transit occurred in 65% of patients and in all the 35 patients complaining of constipation. Delay was pancolonic. All patients had an elevated sensory threshold. The threshold was significantly higher in those with subjective constipation (Po0.01), slow transit (Po0.04) and high SCI (P ¼ 0.046). Mucosal blood flow was lower in SCI patients with constipation (Po0.04) and slow transit (Po0.03). It was higher than normal in high-SCI volunteers (P ¼ 0.056), reflecting loss of sympathetic inhibition. Conclusions: In SCI, subjective constipation correlates closely with slow gut transit. Delay is pancolonic, regardless of the site of lesion. Sensory testing provides evidence for completeness of lesion, offering further evidence for pain transmission through sympathetic pathways. Studies in SCI patients provide further evidence of mucosal blood flow as a marker of altered autonomic innervation.

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