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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_9 | Pages 30 - 30
1 Oct 2022
Theodoraki M Khatri M Carroll J Billington J
Full Access

Background

Cauda Equina Syndrome (CES) needs to be diagnosed and managed promptly to ensure the best outcome for patients. Our current spinal service has been centralised, with referrals currently delivered via an online system. This means that patients aren't seen by spinal specialists until confirmed radiological diagnosis. To ensure patient safety, we must make sure that our CES pathway is as robust as possible.

Methods & Results

A Google Forms questionnaire was emailed to various health professionals involved in the CES patient journey throughout the Lancashire & South Cumbria region. Participants were asked to identify problems with our current pathway and to provide possible solutions for improvement. 64 responses were received from 5 different departments throughout 6 NHS employers: 21 (33%) consultants, 6 (9%) middle grade doctors, 31 physiotherapists (48%), 3 (5%) GPs and 3 (5%) others.

Many common themes were identified: the need to improve CES education to both referrers and patients (22% responses), addressing the issue of scan availability (39% responses), the need for a clearer pathway for GPs (26% responses) among others.

Participants were asked to rate their confidence in the management of both suspected (mean=7.6 +/−2.3) and diagnosed CES (mean=8.0 +/− 2.0).


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_9 | Pages 37 - 37
1 Oct 2022
Trickett H Billington J Wellington K Khatri M
Full Access

Purpose of study and background

Spinal surgery is a high-risk surgical speciality, a patient's understanding of surgical interventions, alternative treatment options, and the benefits and risks must be ascertained to gain informed consent. This pilot study aims to evaluate if the provision of a digital recording of a patient's consultation enhances patient satisfaction, improves recall of clinical diagnosis, recall of treatment options and the risks and benefits of Spinal Surgery.

Methodology and results

A coalition team was identified. A safe and secure process for recording and storage identified. Both qualitative and quantitative data was collected via questionnaires. 62 patients were invited to participate in the pilot, 12 declined. Data was collected immediately post consultation, and two weeks following the consultation via telephone. Comparison was made of the relative increase or decrease in patient recall of the clinical diagnosis, treatment options, and the benefits and the risks of spinal surgery. Patient satisfaction was measured pre- and post- consultation. 50 patients (81%) participated. 32 participants (52%) responded to follow up questionnaire at 2 weeks. Recall of risk for surgical intervention increased by 37%, and of benefit by 36%. Patient satisfaction was rated excellent or very satisfied in 93% at initial consultation and at 2 week follow up all participant's rated satisfaction as excellent or very satisfied.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_9 | Pages 6 - 6
1 Oct 2022
Veerappa P Wellington K Billington J Kelsall C Madi M Berg A Khatri M Austin R Baker A Bourne J
Full Access

Purpose of Study and Background

Degenerative cervical myelopathy resulting in cord compromise is a progressive condition that results in significant quality of life limitations. Surgical treatment options available are anterior and/or posterior decompression of the affected levels. Patients are counselled pre-operatively that the aim of surgical intervention is to help prevent deterioration of neurology. Anecdotal evidence suggested improvements in both EMS and PROMs in this cohort of patients. A 2-year prospective study tested this hypothesis.

Methodology and Results

67 patients undergoing anterior cervical surgery were followed up to two years. Myelopathic features, radiological cord compression, myelomalacia change and levels of surgery were recorded. Pre/post intervention myelopathy scores/grades, and PROM's were recorded. Paired t-test was performed when comparing pre/post intervention scores and Annova test when comparing results across levels. Our prospective study identified statistically significant improvements in European myelopathy scores and grade and patient reported clinical outcomes in the said population.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_10 | Pages 26 - 26
1 May 2017
Hoggett L Anderton M Khatri M
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Background

Advances in surgical and anesthetic technique have resulted in a reducing length of stay for lumbar decompression, with the first day case procedure published in the literature in 1980. Current evidence suggests day case surgery is associated with improved patient satisfaction, faster recovery, reduced infection rates and financial savings. Following the introduction of a locally agreed day case protocol for lumbar microdiscectomy, we reviewed our 30-day postoperative complication rates.

Aims

To review postoperative complication rates for patients who underwent day case primary lumbar microdiscectomy.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_10 | Pages 10 - 10
1 May 2017
Anderton M Hoggett L Khatri M
Full Access

Background

PROMs have become an integral assessment tool of clinical effectiveness and patient satisfaction. To date, PROMs for lumbar discectomy are not an NHS requirement, although voluntary collection via the British Spine Registry is encouraged. Despite this, PROMs for day case microdiscectomy is scarcely reported. We present PROMs for day case microdiscectomy at Lancashire Teaching Hospitals.

Aims

To review PROMs to quantify leg pain, back pain, EQ5D and ODI scores.

Evaluate PROMs data collection compliance.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_10 | Pages 14 - 14
1 May 2017
Wellington K Taylor J Khatri M
Full Access

Purpose of Study/Background

To identify whether patients were satisfied with the overall educational component of the specialist nurse (CNS)/occupational therapist (OT) led pre-operative assessment clinic in order to identify areas which required improvement.

The pre-operative specialist nurse led clinic was set up in 2002. The aim was to provide high quality information to patients undergoing elective spinal surgery in order to manage expectations and optimise post-operative recovery. Initially the clinic was specialist nurse led however, in 2006 occupational therapy input was introduced in order to provide an increased depth of information in regard to function and activities of daily living post operatively. In addition this has allowed assistive equipment to be provided pre-operatively. The format of this clinic has enhanced the patient's journey by facilitating reduced length of stay and more timely discharge.

Methodology

A questionnaire was forwarded to a random sample of two hundred patients who attended for pre-operative assessment in the twelve-month period between April 2014 & March 2015. Sixty questionnaires were returned (30% response rate).


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_2 | Pages 18 - 18
1 Feb 2015
Kelsall C Khatri M
Full Access

Introduction

Orthopaedic Spinal Rapid Access Service (OSRAS) was developed in our institute to provide a structured pathway for management of urgent spinal pathologies during working hours of Monday to Friday. It was delivered through a published rota by a multi displinary team of Extended Scope Practitioner carrying a bleep and a Spinal Surgeon.

Aim

To evaluate the efficacy of OSRAS through a prospective audit.


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_2 | Pages 14 - 14
1 Feb 2015
Vadhva M Hoggett L Khatri M
Full Access

Aim

To assess the safety of Zero Profile Interbody fusion (Zero P) device in Anterior Cervical Decompression and fusion (ACDF) for degenerative cervical stenosis.

Method

89 consecutive patients treated with Zero P interbody device from September 2009 to September 2012 were included in this retrospective study.

Inclusion criterion: degenerative cervical stenosis with myelopathy, persistent radiculopathy after at least 3 months of failed conservative management.

Exclusion criterion: Paediatric population; patients with infection, metastatic disease and trauma.

There were 39 females, 50 males with mean age of 55 (ranging from 24 to 84 years)

56 (64%) had surgery at 1 level, 31 (35%) at 2 levels, 1 (1%) at 3 levels. Total number of levels operated were 121. Common levels operated were C56 (62%) and C67 (47%)

Majority were operated due to radicular symptoms, 56 (64%) had radicular symptoms, 28(31%) had myelopathy and 5 (5%) Myeloradiculopathy


Orthopaedic Proceedings
Vol. 97-B, Issue SUPP_2 | Pages 8 - 8
1 Feb 2015
Hoggett L Carter S Vadhva M Khatri M
Full Access

Aim

To assess the safety of day case lumbar decompressive surgery

Method

Retrospective study of 233 consecutive patients undergoing DCLDS who were identified from a prospective electronic database.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_4 | Pages 37 - 37
1 Feb 2014
Dunderdale C Jones F Billington J Khatri M
Full Access

Introduction

Spinal conditions commonly cause pain and disability. Various non-operative treatments including acupuncture are practiced for these conditions.

Aim

To evaluate the effectiveness of acupuncture in management of common spinal conditions.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_4 | Pages 15 - 15
1 Feb 2014
Carter S Ali S Khatri M
Full Access

Introduction

Both intra- and post-operative radiographs are traditionally obtained after instrumented lumbar spinal surgery; however the clinical advantage of routine post operative images has not been demonstrated.

Aim

To explore the usefulness of routine pre-discharge postoperative radiographs in patients undergoing instrumented spinal surgery.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_17 | Pages 8 - 8
1 Apr 2013
Dunderdale CS Wellington K Khatri M
Full Access

Aim

To investigate the role of websites in enhancing patients' understanding of reason and risk of surgery as a part of informed consent for elective un-instrumented lumbar spine surgery (EULSS).

Methodology

This was a National Research Ethical Committee approved RCT study. 63 patients underwent EULSS, out of which 14(29%) declined participation and 14(29%) were excluded. One did not have surgery therefore 34 were randomised to Standard (S) and intervention group (I) using sealed envelope. Standard group were given verbal information & leaflet while the Intervention group were given information on relevant section of www.eurospine.org and www.spinesurgeons.ac.uk websites. A 13 item Informed Consent Questionnaire (ICQ) was used to collect data. The primary outcomes were patients' perceived understanding of reason and risk of EULSS.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_17 | Pages 14 - 14
1 Apr 2013
Childs J Khatri M
Full Access

Aim

The aim of this study is to evaluate the causes of litigation in spinal surgery and to identify preventable causes.

Methods

Retrospective analysis of all claim data made available under Freedom of information act from NHS Litigation Authority between years 2000 to 2010.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 45 - 45
1 Jun 2012
Pulavarti R Vadhva M Wellington K Khatri M
Full Access

Aim

Assess efficacy of caudal epidural injection with epidurogram with validated outcome measures.

Introduction

The administration of local steroids and other drugs into caudal epidural space has been well established procedure in the management of low back pain with or without leg symptoms. Various studies have been done to assess the efficacy of the different routes of administration of epidural injections. However, only a few published prospective studies have been done on performing caudal epidural injections under fluoroscopic guidance with validated outcome measures.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 491 - 491
1 Nov 2011
Warren A Mackarel D Wellington K Khatri M
Full Access

Aim: To evaluate patient satisfaction between telephone and traditional outpatient appointments following un-instrumented spinal surgery.

Material and Methods: The study was approved by the local audit committee. Fifty seven patients who underwent un-instrumented lumbar spinal micro-decompressive surgery in 2008 were identified from Bluespiers database and were contacted by telephone. A predesigned proforma was used to collect data. Ten patients had not yet had follow-up at the time of study and were excluded. Results of 47 patients were analysed and are described. No loss to follow up was encountered.

Results: Average age was 60 (Range 23 to 89 years) with 21 male (45%) and 26 female (55%). Majority (77%) of patients rated telephone follow-up as good or excellent. Average delay between scheduled appointment time and contact with the clinician was 47 minutes in traditional clinic. Majority (84%) of patients were contacted in time in telephonic clinic with minority (16%) experienced an average delay of 28 minutes. Majority (93%) of patients would recommend telephone follow up clinic and (70%) reported telephone follow-up was better or much better than traditional clinic. Reasons for preferring telephone follow-up included delay in the clinic, saving travel time and no need to find parking space. Six percent were dissatisfied with telephone clinic the reason being hearing impairment and desire to discuss their condition face-to-face.

Conclusion: Telephone follow-up clinic for un-instrumented spinal surgery appears to be a safe cost effective satisfactory alternative for the majority of patients. However traditional clinical follow up may be required for a proportion of patients.

Conflict of Interest: None

Source of Funding: None


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_I | Pages 29 - 29
1 Jan 2011
Siddique I Hakimi M Javed S Wellington K Smith R Khatri M
Full Access

Current evidence on the indications for and efficacy of non-rigid lumbar stabilisation remains unclear. The aim of this study was to review the outcome of the DYNESYS system (Zimmer, Inc.) in a consecutive series of 34 patients undergoing this procedure between 2001 and 2006.

Prospectively collected outcome measure data obtained pre-operatively and at 1 year post-operatively was analysed using the Wilcoxon Signed Rank Test. Kaplan Meier survival analysis was performed using revision surgery as the end point. Cox Regression was utilised to identify variables that were related to implant survival.

Pain rating on the visual analogue scale improved from a mean of 7 pre-op to 4 at 1 year (p=0.009), Roland Morris Disability Questionnaire scores from 13 to 9 (p=0.02), Modified Somatic Perception Questionnaire from 13 to 9 (p=0.03). When reporting subjective outcome, 54% of patients reported “better” or “much better” outcomes at last followup (12–69 months post op). Eight patients (25%) required removal of the implant and conversion to fusion, one of whom had deep infection. Kaplan Meier survival analysis revealed a survival of 78% at 5 years (95% CI, 60 – 96%). Previous spinal surgery was significantly related to the time of survival of the implant (p=0.008).

Our study has demonstrated a high revision rate for this implant and 54% patient satisfaction. We recommend that patients be counseled regarding these risks and further use of this implant should be subject to the outcome of larger studies and randomised controlled trials.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_I | Pages 29 - 29
1 Jan 2011
Khatri M Norris H Ross R
Full Access

Sub-optimal positioning of the implant is thought to be related to poor outcome after Lumbar Disc Replacement. Our aim was to analyse the impact of implant position in the outcome of Charite III Disc Replacement implants.

160 Charite III Lumbar Disc Replacements that were implanted between 1990 and 2000. The average age was 46 years with 62 Males and 98 Female subjects. An independent observer (HN) administered Pain score (VAS 1–10) for Low Back Pain (LBP) and Oswestry Disability Index (ODI). These clinical outcome parameters were compared with coronal and sagittal position of the implants from the latest available radiographs. Those with operation at L3L4 (small numbers = 20) and inadequate radiographs were excluded.

48 implants were optimally placed and 70 implants were placed sub optimally. Both the groups were in similar age groups (45.02 years, SD 7.61 and 48.31 years, SD 8.04). Clinical: No statistical or clinically significant difference was observed in LBP on VAS (4.92 V/S 4.41), ODI (42.8 V/S 38.0) and in Patient Satisfaction at an average follow up of 70 months. Average movement at optimally placed discs at L4L5 was 4.4o(95% CI 2.3 – 6.7) and at L5S1 was 5.9o(95% CI 4.2 – 7.5) and at sub optimally placed disc at L4L5 was 3.8o(95% CI 2.4 – 5.1) and at L5S1 was 3.8o(95% CI 2.3 – 5.3).

Clinical and radiological results after Charite III Disc Replacement is NOT dependent on positioning of implants. Movements at optimally placed implants are better but is of questionable clinical relevance.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 381 - 381
1 Jul 2010
Siddique I Khatri M Norris H Ross R
Full Access

Aim: To analyse the impact of implant position in the outcome of Charite III Disc Replacement implants.

Methodology: 160 Charite III Lumbar Disc Replacements that were implanted between 1990 and 2000. The average age was 46 years with 62 Males and 98 Female subjects. An independent observer (HN) administered Pain score (VAS 1–10) for Low Back Pain (LBP) and Oswestry Disability Index (ODI). These clinical outcome parameters were compared with coronal and sagittal position of the implants from the latest available radiographs. Those with operation at L3L4 (small numbers = 20) and inadequate radiographs were excluded.

Results: 48 implants were optimally placed and 70 implants were placed sub optimally. Both the groups were in similar age groups (45.02 years, SD 7.61 and 48.31 years, SD 8.04). Clinical: No statistical or clinically significant difference was observed in LBP on VAS (4.92 V/S 4.41), ODI (42.8 V/S 38.0) and in Patient Satisfaction at an average follow up of 70 months. Movements: Average movement at optimally placed discs at L4L5 was 4.4o(95% CI 2.3–6.7) and at L5S1 was 5.9o(95% CI4.2–7.5) and at sub optimally placed disc at L4L5 was 3.8o(95% CI 2.4–5.1) and at L5S1 was 3.8o(95%CI 2.3–5.3).

Conclusions: Clinical and radiological results after Charite III Disc Replacement is NOT dependent on positioning of implants.

Ethics approval: None

Interest Statement: None


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 382 - 383
1 Jul 2010
Siddique I Hakimi M Javed Z Smith R Khatri M
Full Access

Introduction: Current evidence on the indications for and efficacy of non-rigid lumbar stabilisation remains unclear. The aim of this study was to review the results of this system in thirty four patients who underwent this procedure between 2002 and 2006.

Methods & Results: Validated outcome measures including Visual Analog Score (VAS), Roland Morris Disability Questionnaire (RMDQ), Modified Zung Score and Modified Somatic Perception Questionnaire (MSPQ) were evaluated preoperatively and at 1 year post operatively. Subjective patient outcome (much better, better, same, worse) was assessed at final followup Kaplan-Meier Survival analysis was performed using need for revision surgery as endpoint. The indications for surgery in thirty patients was radicular pain and back pain, these patients underwent discectomy (12 patients) or decompression (18 patients) in addition to Dynesys. Two patients who had only back pain underwent Dynesys alone. There were statistically significant improvements in VAS, RMDQ, Modified Zung and MSPQ scores at 1 year. However at final followup 46% of patients had a unsatisfactory subjective patient outcome (worse or the same). 25% of patients required revision surgery (posterolateral fusion) for ongoing pain (seven patients) or infection (one patient).

Conclusion: We recommend that all patients undergoing this procedure are counselled regarding the high rate of revision surgery and patient dissatisfaction. Routine use of this implant should be subject to the findings of larger studies and randomised controlled trials.

Ethics approval: None

Interest Statement: None


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 231 - 231
1 Mar 2010
Siddique I Hakimi M Javed S Smith R Khatri M
Full Access

Introduction: Current evidence on the indications for and efficacy of non-rigid lumbar stabilisation remains unclear. The aim of this study was to review the results of this system in thirty four patients who underwent this procedure between 2002 and 2006.

Methods & Results: Validated outcome measures including Visual Analog Score (VAS), Roland Morris Disability Questionnaire (RMDQ), Modified Zung Score and Modified Somatic Perception Questionnaire (MSPQ) were evaluated preoperatively and at 1 year post operatively. Subjective patient outcome (much better, better, same, worse) was assessed at final followup Kaplan-Meier Survival analysis was performed using need for revision surgery as endpoint. The indications for surgery in thirty patients was radicular pain and back pain, these patients underwent discectomy (12 patients) or decompression (18 patients) in addition to Dynesys. Two patients who had only back pain underwent Dynesys alone. There were statistically significant improvements in VAS, RMDQ, Modified Zung and MSPQ scores at 1 year. However at final followup 46% of patients had a unsatisfactory subjective patient outcome (worse or the same). 25% of patients required revision surgery (posterolateral fusion) for ongoing pain (seven patients) or infection (one patient).

Conclusion: We recommend that all patients undergoing this procedure are counselled regarding the high rate of revision surgery and patient dissatisfaction. Routine use of this implant should be subject to the findings of larger studies and randomised controlled trials.