Background:The median orthopedic surgery wait time in Canada is 33.7 weeks, thus alternative treatments for pathologies such as lumbar disc herniations (LDH) are needed. We sought to determine whether transforaminal epidural steroid injections (TFESIs) alleviate or merely delay the need for surgery. Methods:We retrospectively reviewed the charts of patients with LDH who received TFESIs between September 2006 and July 2008. Patient demographics, level and side of pathology, workers' compensation status, levels injected, treatment outcome and time from referral to treatment were evaluated. The primary outcome measure was the need for versus the avoidance of surgery. Results:We included 91 patients in our analysis. Time from family physician referral to injection was 123 (standard deviation [SD] 88) days; no significant differences in wait times were found between TFESI patients and those requiring surgery. In all, 51 patients (22 women, 29 men) with a mean age of 45.8 (SD 10.2) years avoided surgery following TFESI, whereas 40 patients (16 women, 24 mean) with a mean age of 43.1 (SD 12.0) years proceeded to surgery within 189 (SD 125) days postinjection. In all, 15 patients received multiple injections, and of these, 9 did not require surgical intervention. Age, sex and level/side of pathology did not influence the treatment outcome. Workers' compensation status influenced outcome significantly; these patients demonstrated less benefit from TFESI. Conclusion:Transforaminal epidural steroid injections are an important treatment tool, preventing the need for surgery in 56% of patients with LDH.

This paper describes a project that combined physical model fabrication and virtual computerbased data display to create a unique visualization presentation. USGS terrain information on Prince of Wales Island, Alaska was used to create a physical prototype in SDSC's TeleManufacturing Facility. This model was then used as a mold to create a translucent plate of the terrain. Finally, deforestation data from the island was color mapped and rear-projected onto the translucent plate within a light box. The result is a very compelling display in which both the senses of sight and touch are used to make relationships between terrain features and the data more readily apparent.

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