INTRODUCTIONThere are number of studies which have shown prevalence rate of low back pain (LBP) to be approximately 22% to 65% in one year and lifetime prevalence to be in the range of 29% to 70%. In 60% to 75% patients suffering from LBP, causative factors are muscle pain or ligament injuries. In 5% to 15% of patients LBP is associated with degenerative joints and disc disease. 1 The short term success rate after surgery for disc herniation is approximately 95-98% which decreases to 88% in long term.2 These findings have led to research ABSTRACT Background: Intradiscal injection of Oxygen-Ozone (O 2 -O 3 ) and intraforaminal steroid is a minimaliy invasive procedure for treatment of low back pain due to prolapsed intervertebral disc. About 9 out of 10 adults experience at least one episode of low back pain at some point in their lifetime. It has been studied that intradiscal and intraforaminal injection of mixture of O 2 -O 3 and steroid produces good outcome than steroid only in such patients. The aim of the study was to evaluate long term therapeutic outcome of Intradiscal injection of Oxygen-Ozone (O 2 -O 3 ) and intraforaminal steroid in Indian population. Methods: There were 98 patients who were treated with intradiscal injection of O2-O3 and intraforaminal steroid 4 years' back. All of them had clinical signs of lumbar nerve root compression along with CT and/or MR evidence of contained disk herniation. Eighty two patients were available for follow-up at 4 years. Retrospective study was carried out in those patients. All patients received about 3.5 to 4.0 ml of intradiscal O2-O3 mixture at concentration of 20-24-microgram/ml and intraforaminal injection of 40 mg of inj. Trimnicelone along with 2ml of local anesthetic. Clinical outcome after the injection was assessed by Modified MacNab method and the success of treatment was assessed by means of a visual analog pain scale and the Oswestry Disability Index. Results: A significant reduction in the VAS was observed after 6 weeks and 6 months (from 8.6 to 5.4 and 6.0; p<0.001) in all patients; an excellent therapy response (VAS below 3.0) was achieved at 4 years. A significant improvement in ODI was registered in all patients (36 to 14.8; p < 0.001). Patients below 50 years had significantly better values in the VAS and the ODI score 4 years after treatment. Final VAS and ODI scores for patients with a single diseased segment were 4.2 and 28.0. The total effective rate according to Modified MacNab method (excellent and good /fair) was 93.9% at end of 6 months, 97.55% at 1 year and 4 years it was 97.55%. No patient was operated for spine surgery. Conclusions: Intradiscal injection of O2-O3 and intraforaminal steroid is highly effective in relieving lower back pain in patients with lumbar disc herniation not responding to conservative therapy. There was significant clinical outcome even after 4 years.

INTRODUCTIONThe cost of health care delivery is increasing everyday. Hence there is need for healthcare teams to encourage cost effectiveness in every aspect of patient care. It also leads to prolonged hospital stay and in many cases repetition of various aspects of pre-operative preparation. Apart from economic loss to hospital, it is also stressful for patients and their families. All of these increase patients therapeutic expense. Avoidance of cancellation of elective surgery, therefore should lead to reduction in the overall cost of treatment.In UK 8% of scheduled elective operations are cancelled nationally, within 24 hours of surgery.1 In total 10 to 40% of booked elective operations are cancelled before the surgery takes place. The reasons include cancellation by the patient, cancellation for poorly optimized medical conditions or cancellations due to poor organization, lack of co-ordination among the surgical team and the anaesthetist, or sometimes poor co-ordination between the patient and the hospital administration.2 A variety of studies have examined the reasons for late cancellations based on the retrospective analysis of hospital records. [3][4][5][6][7][8][9][10][11][12] This audit was a retrospective study in a medical teaching hospital. The aim was to assess the causes of cancellation of orthopedic procedures scheduled on day of surgery and ABSTRACT Background: A retrospective observational study was conducted to find out the reasons for cancellation of elective orthopedic surgical inpatients on the day of surgery and to plan for future suggestive actions to decrease unnecessary cancellations. Methods: This was a retrospective observational study conducted at medical teaching hospital for 3 years from January 1, 2012 to December 31, 2014. The data was collected from postponement register. The files of cases that were cancelled were reviewed for the reasons of cancellations. The reasons were classified as anaesthetist related, administrative issues, surgeon related and patient related issues. Results: During the study period, 7673patients were posted for elective orthopedic procedures. 6.49 % patients were cancelled on the day of surgery. The frequency of cancellations was more in anesthetist related issues (38.9%). Cancellations due to administrative issues, patient related issues and surgeon related were 30%, 27.7% & 3.4% respectively. Conclusions: Although cancellations were only 6.49% of total elective operations, this can be reduced by implementing and following the recommendations that have been proposed. More thorough and detailed documentation is needed to achieve this.