Aims. The escalating demand for medical resources to address spinal diseases as society ages is an issue that requires careful evaluation. However, few studies have examined trends in
Objectives: To surgery the UK Specialist Orthopaedic Registrars (SpRs) to assess their perceptions of and attitudes towards
Adverse events (AEs) are still a major problem in
Introduction: Following the publication of our original survey in 2000 (. Eur. Sp. J. 11. (6):. 515. –8 . 2002. ) we have sought to re-evaluate the perceptions and attitudes towards
Background. Over 55,000 spinal operations are performed annually in the NHS. Effective postoperative analgesia facilitates early mobilisation and assists rehabilitation and hospital discharge, but is difficult to achieve with conventional, opioid-based, oral analgesia. The clinical and cost-effectiveness of two alternative techniques, namely intrathecal opioid and the more novel erector-spinae plane blockade, is unknown. The Pain Relief After Instrumented
Neurological complications in oncological and degenerative spine surgery represent one of the most feared risks of these procedures. Multimodal intraoperative neurophysiological monitoring (IONM) mainly uses methods to detect changes in the patient's neurological status in a timely manner, thus allowing actions that can reverse neurological deficits before they become irreversible. The utopian goal of
Informed consent is a very important part of surgical treatment. In this paper, we report a number of legal judgements in
In recent years, machine learning (ML) and artificial neural networks (ANNs), a particular subset of ML, have been adopted by various areas of healthcare. A number of diagnostic and prognostic algorithms have been designed and implemented across a range of orthopaedic sub-specialties to date, with many positive results. However, the methodology of many of these studies is flawed, and few compare the use of ML with the current approach in clinical practice.
Aims. The current pandemic caused by COVID-19 is the biggest challenge for national health systems for a century. While most medical resources are allocated to treat COVID-19 patients, several non-COVID-19 medical emergencies still need to be treated, including vertebral fractures and spinal cord compression. The aim of this paper is to report the early experience and an organizational protocol for emergency
Purpose of study and background.
With the identification of literature shortfalls on the techniques employed in intraoperative navigated (ION)
During the pandemic of COVID-19, some patients with COVID-19 may need emergency surgeries. As spine surgeons, it is our responsibility to ensure appropriate treatment to the patients with COVID-19 and spinal diseases. A protocol for
The Spine Surgery Unit of IRCCS Istituto Ortopedico Rizzoli is dedicated to the diagnosis and the treatment of vertebral pathologies of oncologic, degenerative, and post-traumatic origin. To achieve increasingly challenging goals, research has represented a further strength for
Introduction. To face the problem of surgical complications, which is generally relevant in surgical fields, an intraoperative checklist (Safety Surgical Checklist, SSC) was elaborated and released by the World Health Organization in 2008, and its use has been described in 2009. In our Institution, the WHO SSC was introduced in 2011. In
The COVID-19 pandemic creates unique challenges in the practice of
There is an inherent risk of iatrogenic new neurological deficit (NND) arising at the spinal cord, cauda equina and nerve root during
Minimal clinically important differences (MCID)
in the scores of patient-reported outcome measures allow clinicians to
assess the outcome of intervention from the perspective of the patient.
There has been significant variation in their absolute values in
previous publications and a lack of consistency in their calculation. The purpose of this study was first, to establish whether these
values, following
Introduction A prospective cohort study was conducted to assess the incidence of venous thromboembolism (VTE) in 300 patients undergoing elective
Introduction. Guidelines from the North American Spine Society (2009 and 2013) are the best evidence-based instructions on venous thromboembolism (VTE) and antibiotic prophylaxis in
Introduction. Following the publication of our original survey in 2000 (Eur. Sp. J. 11(6):515-8 2002) we have sought to re-evaluate the perceptions and attitudes towards
Lumbar
Purpose: To review the existing practice of coding in
Aim. The aim of this study is to evaluate the causes of litigation in
Venous Thromboembolism (VTE) is the most common complication following major joint surgery. While attention has focused on VTE following joint arthroplasty their exists a gap in the literature examining the incidence of VTE in
Between January 1999 and December 2000, 82 patients who had undergone previous
To review blood transfusion practices during elective
Introduction. Many journals require outcome data at 2 years post-operative for the assessment of operative procedures in
PURPOSE OF THE STUDY. The anterior approach to the thoracic and lumbar spine is used with increasing frequency for various indications. With the advent of prosthetic intervertebral disc replacement, its use has become even more frequent and has often been associated with serious complications. The aim of this study was to evaluate vascular complications in patients who underwent anterior
To evaluate the prevalence of infection after elective
Introduction: In order to improve the provision of
Background. The majority of studies assessing minimal clinical important difference in outcome do so for management of chronic low back pain. Those that identify MCID following spinal surgical intervention fail to differentiate between the different pathologies and treatments or use variable methods and anchors in the calculation. Aim. To identify the MCID in scores across the most common spinal surgical procedures using standardised methods of calculation. Method. Prospective longitudinal study following elective lumbar
To quantify the expected shortage of Orthopaedic Specialist Registrars (SpRs) planning careers in
Aims. With resumption of elective spine surgery services in the UK following the first wave of the COVID-19 pandemic, we conducted a multicentre British Association of Spine Surgeons (BASS) collaborative study to examine the complications and deaths due to COVID-19 at the recovery phase of the pandemic. The aim was to analyze the safety of elective
An independent audit of Lumbar
Background: Autologous bone graft remains the “gold standard”, but the associated morbidity and finite supply of tissue has resulted in surgeons seeking methods of enhancing healing with bone graft substitutes and bone morphogenic proteins (BMPs). There are 54 bone graft substitutes and 2 BMPs currently on sale in the UK. The aim of this study was to review the published clinical evidence in support of their use in
This study was conducted to quantify the incidence of gastrointestinal morbidity and identify risk factors for developing gastrointestinal morbidity following
Introduction. Traditionally complex
Introduction This study was conducted to quantify the incidence of gastrointestinal morbidity and identify risk factors for developing gastrointestinal morbidity following
There is increasing knowledge regarding the functional outcome of patients following posterior lumbar
Purpose: Purpose of the study was to evaluate the incidence of
Objective: To analyse the incidence and gravity of reported complications that arise in
Purpose: Back pain is a significant problem in Europe with important socio-economic impact. The purpose of this study was to evaluate the incidence of
Aim: To establish the effectiveness of using the intra-operative cell saver in
Introduction: Surgical Site Infection (SSI) in
Introduction: Surgical Site Infection (SSI) in
Objective: To analyse the incidence and gravity of reported complications that arise in
Aims: To determine outcomes in somatised patients and identify factors of clinical utility that help predict favourable and unfavourable results. Introduction: Somatisation is a tendency to experience and express somatic distress and symptoms unaccounted for by pathological findings and to attribute them to physical illness, often with excess seeking of medical help for them. Somatised patients undergoing
A dural tear is a common but troublesome complication of endoscopic
Aim of Study: The aim of the study was to investigate the effect of muscle retractors on intramuscular pressure in the posterior spinal muscles during posterior
Since several spinal conditions are currently treated with spinal fusion, alternatives to autogenous bone graft in
The surgical treatment of spinal deformities and degenerative or oncological vertebral diseases is becoming more common. However, this kind of surgery is complex and associated to a high rate of early and late complications. We retrospectively collected all the major complications observed in the perioperative and post-operative period for surgeries performed at our Division of Spine Surgery in the 2010–2012 period,. 285 surgeries were registered in 2010, 324 in 2011 and 308 in 2012. All the complications observed during the procedure and the follow-up period were recorded and classified according to the type (mechanical complications, neurological complications, infection, hematoma, cerebrospinal fluid fistula, systemic complications, death related to the surgery). In 2010, on 285 surgeries 47 patients (16.5 %) had 69 complications (24.2%): 25.7% for the treatment of oncological diseases, 23% for the treatment of degenerative diseases, 27% for the treatment of pathologies of traumatic origin, 11% for the treatment of spondylodiscitis (infectious diseases). In 2011, on 324 surgeries 35 patients (10.8 %) had 54 complications (16.7%): 16.3% for the treatment of oncological diseases, 16.3% for the treatment of degenerative diseases, 20% for the treatment of pathologies of traumatic origin, 28.6% for the treatment of spondylodiscitis. In 2012, on 308 surgeries, 25 patients (8.1 %) had 36 complications (11.7%): 14.4% for the treatment of oncological diseases, 7.2% for the treatment of degenerative diseases, 16.7% for the treatment of pathologies of traumatic origin, 20% for the treatment of spondylodiscitis. On 917
Introduction: Accurate and ethical coding is challenging and directly impacts on Payment by Results (PbR). The aims &
objectives of this study were to review the existing pattern of coding for
Purpose: Thoracoscopic
To introduce a new robot-assisted surgical system for spinal posterior fixation which called TiRobot, based on intraoperative three-dimensional images. TiRobot has three components: the planning and navigation system, optical tracking system and robotic arm system. By combining navigation and robot techniques, TiRobot can guide the screw trajectories for orthopedic surgeries. In this randomised controlled study approved by the Ethics Committee, 40 patients were involved and all has been fully informed and sign the informed consent. 17 patients were treated by free-hand fluoroscopy-guided surgery, and 23 patients were treated by robot-assisted
Surgery of the spine is associated with blood loss and frequently transfusion, with consequent risk of infection and reactions. It also costly, and puts a strain on national blood banks. A new blood salvage device works by ‘washing’ and centrifuging the blood lost during surgery; which can then be re-transfused into the patient. In a retrospective study 46 consecutive
Introduction: Radiation dose exposure to patients in a main X-ray department in a hospital is well documented and controlled. Few studies report the radiation exposure to patients undergoing
Aim. Spinal infection is the most frequent complication of spine surgery. Its incidence varies between 1% and 14% in the literature, depending on various studied populations and surgical procedures. The aim of this study was to describe a consecutive 2706 case series. Method. We analyzed a prospective cohort of 2706 patients operated for spine disease between 2013 and 2016 in a University Hospital. The infection rates, germs, time between surgery and infection and outcomes after surgical revision were assessed with a minimum follow-up of 7 months. We developed a mathematical model to analyze risk factors in this difficult-to-treat population. Results. Among 2706 patient who underwent
Scoliosis correction surgery is one of the longest and most complex procedures of all orthopedic surgery. The complication rate is therefore not negligible and is particularly high when the surgery is performed in patients with neuromuscular or connective tissue disease or complex genetic syndromes. In fact, these patients have various comorbidities and organ deficits (respiratory capacity, swallowing / nutrition, heart function, etc.), which can compromise the outcome of the surgery. In these cases, an accurate assessment and preparation for surgery is essential, also making use of external consultants. To make this phase simpler, more effective and homogeneous, a multidisciplinary path of peri-operative optimization is being developed in our Institute, which also includes the possibility of post-operative hospitalization for rehabilitation and recovery. The goal is to improve the basic functional status as much as possible, in order to ensure faster functional recovery and minimize the incidence of peri-operative complications, to be assessed by clinical audit. The path model and the preliminary results on the first patients managed according to the new modality are presented here. The multidisciplinary path involves the execution of the following assessments / interventions: • Pediatric visit with particular attention to the state of the upper airways and the evaluation of chronic or frequent inflammatory states • Cardiological Consultation with Echocardiogram. • Respiratory Function Tests, Blood Gas Analysis and Pneumological Consultation to evaluate indications for preoperative respiratory physiotherapy cycles, Non-Invasive Ventilation (NIV) cycles, Cough Machine. Possible Polysomnography. • Nutrition consultancy to assess the need for nutritional preparation in order to improve muscle trophism. • Consultation of the speech therapist in cases of dysphagia for liquids and / or solids. • Electroencephalogram and Neurological Consultation in epileptic patients. • Physiological consultation in patients already being treated with a cough machine and / or NIV. • Availability of postoperative hospitalization in the rehabilitation center (with skills in respiratory and neurological rehabilitation) for the most complex cases. When all the appropriate assessments have been completed, the anesthetist in charge at our Institute examines the clinical documentation and establishes whether the path can be considered complete and whether the patient is ready for surgery. At the end of the surgery, the patient is admitted to the Post-operative Intensive Care Unit of the Institute. If necessary, a new program of postoperative rehabilitation (respiratory, neuromotor, etc.) is programmed in a specialist reference center. To date, two patients have been referred to the preoperative optimization path: one with Ullrich Congenital Muscular Dystrophy, and one with 6q25 Microdeletion Syndrome. In the first case, the surgery was performed successfully, and the patient was discharged at home. In the second case, after completing the optimization process, the surgery was postponed due to the finding of urethral malformation with the impossibility of bladder catheterization, which made it necessary to proceed with urological surgery first. The preliminary case series presented here is still very limited and does not allow evaluations on the impact of the program on the clinical practice and the complication rate. However, these first experiences made it possible to demonstrate the feasibility of this complex multidisciplinary path in which a network of specialists takes part.
HIV and musculoskeletal trauma have reached epidemic proportions in the developing world especially in sub Saharan Africa. The epidemic has adversely affected health care delivery in limited resource settings. We assessed the outcome of HIV+ patients following
Introduction: Postoperative overdistention of the bladder produces chronic, irreversible changes in the detrusor muscle. This study investigated whether an effective epidural, may cause postoperative overdistention of the bladder. Methods: A retrospective single surgeon/unit study of 144 male patients who had undergone
Introduction Surgeons request cross-match based on habit not evidence. The spinal unit requested 686 units of blood during 2002–2003 and transfused only 42 for elective lumbar spine surgery. This wastes money, time and blood. Aim Optimise the transfusion requests in elective lumbar
Introduction: In 1998 the British Scoliosis Society was asked by the Board of Affiliated Societies to the BOA to provide information concerning the activity, numbers and training implications for specialists in our field. We had no systematic data so with the valuable assistance of the BOA a survey of
Introduction and Aims: To assess the effectiveness of intrathecal fentanyl in the relief of post-operative pain in patients undergoing
Objective: To assess the effectiveness of intrathecal fentanyl in the relief of post operative pain in patients undergoing lumbar decompression or fusion. Morphine has been shown to be effective intrathecally in
Use of epidural analgesia post-operatively in
Background: Clonidine is an 2 adrenoreceptor and imidazoline receptor agonist which has analgesic, sedative and MAC sparing effects. It has been used orally, intravenously (including as an additive to morphine in PCA devices) and epidurally in combination with local anaesthetics and alone. We hypothesised that epidural administration of clonidine without local anaesthesia might provide adequate postoperative analgesia following
To evaluate the effect of wait time to surgery on patient derived generic and disease-specific functional outcome following lumbar surgery. Study cohort of seventy patients undergoing elective posterior lumbar
Study Design: Prospective randomized double blind trial. Objective: To assess the effectiveness of intrathecal fentanyl in the relief of post operative pain in patients undergoing lumbar decompression or fusion. Summary of Background Data: Morphine has been shown to be effective intrathecally in
Introduction: Spinal surgical procedures are associated with significant morbidity. It is vital the patients are aware of the potential complications and the implications. The General Medical Council published guidelines regarding consent in June 2008. Aim: To examine the adequacy for consenting for spinal surgical procedures and focussing on documentation of serious risks. Methods: Case notes of seventy consecutive patients who had undergone
Background/purpose: Clinical outcomes of surgery for disc herniation and spinal stenosis are variable. Surveys show that post-operative management is inconsistent, and spinal surgeons and their patients are uncertain about what best to do during the recovery phase. The aim of this study was to develop a patient-centred, evidence-based booklet that spinal surgeons can give to their patients to reduce uncertainty, guide post-operative management and facilitate recovery. Methods: A systematic literature search led to a best-evidence synthesis of appropriate information and advice on post-operative activation, restrictions, rehabilitation, and expectations about surgical and functional outcomes. Data were extracted into evidence statements which were graded by consensus for consistency and practicality so as to inform and prioritise the booklet’s messages. Following peer review (n = 16), a sample of patients (n = 11) gave a structured evaluation of the draft text. Results: The review found scant evidence in favour of post-operative activity restriction, yet an early active approach to post-operative rehabilitation can improve clinical, functional and occupational outcomes. Thus, the text of the booklet presents carefully selected messages to reduce uncertainty, promote positive beliefs, encourage early reactivation, and provide practical advice to aid self-management. Peer reviewers’ comments were incorporated into the text; all the spinal surgeons (n = 7) said they would find the booklet useful. Patients found it readable, interesting and helpful; they understood and accepted the intended messages. Conclusions: Following careful development, an evidence-based booklet to aid post-operative management in
Introduction. Our clinic has started to use MAZOR's Spine-Assist(r) robotic device in routine
In the NHS the structure of a “regular healthcare team” is no longer the case. The NHS is facing a workforce crisis where cross-covering of ward-based health professionals is at an all-time high, this includes nurses, doctors, therapists, pharmacists and clerks. Comprehensive post-operative care documentation is essential to maintain patient safety, reduce information clarification requests, delays in rehabilitation, treatment, and investigations. The value of complete surgical registry data is emerging, and in the UK this has recently become mandated, but the completeness of post-operative care documentation is not held to the same importance, and at present there is no published standard. This project summarises a 4-stage approach, including 6 audit cycles, >400 reviewed operation notes, over a 5 year period. To deliver a sustainable change in post operative care documentation practices through quality improvement frameworks.Abstract
INTRODUCTION
OBJECTIVE
Patients have an important role in evaluating the health-care they receive; including the treatment they receive as well as the healthcare process. This information can be invaluable in understanding patient needs and developing a more patient centred approach to health care. As part of an RCT into the post-operative management of
Clinical outcomes of surgery for disc herniation and spinal stenosis are variable. Surveys show that postoperative management is inconsistent; spinal surgeons and their patients are uncertain about what best to do post-operatively. Following a focused literature review, a patient-centred, evidence-based booklet was developed, which aims to reduce uncertainty, guide post-operative management and facilitate recovery. Initial peer and patient evaluations were encouraging and the booklet Your back operation (. www.tso.co.uk/bookshop. ) is currently factored into a trial investigating the post-operative management of spinal patients. To date, 80 patients have been recruited into the study of which 34 have been randomised to receive the booklet. At 6 months post-surgery all of these patients are requested to complete a questionnaire on the booklet. This questionnaire contained forced-choice questions on readability, style, information level, believability, length, content and helpfulness. Further open questions concern the booklet’s messages, giving patients the opportunity to identify anything they did not like or understand, voice any concerns that were not covered, and say if they thought the booklet would change what they did after surgery. Finally, they were asked their overall rating of the booklet on a scale from 1 to 10. Feedback is very positive. The average overall rating of the booklet was 8.6/10. Over 80% found it easy to read, interesting, and of appropriate length. Over 80% also stated they had learnt new and helpful information. All subjects stated that they would recommend the booklet to a friend, and the majority stated that they frequently referred to the booklet. The predominant messages received and understood by the patients were related to the safe benefits of early activation and return to normal activities. The results show that
BACKGROUND: Physical outcomes following surgery for degenerative spine disease have been well studied. It is only relatively recently however that the importance of psychological factors in determining outcome from spine surgery has been addressed. Previous studies suggest that pre-operative psychological distress is a predictor of poor outcome. In the drive to identify patients who will not benefit from spine surgery these patients may in future be denied surgery. AIM: The aim of the current study was to examine the relationship between the severity of physical symptoms, levels of pre-operative psychological distress and out-come in patients with degenerative spine disease undergoing elective
The volume of spinal procedures have increased over the last two decades (220% in lumbar region). A simultaneous increase in re-operation rates (up to 20%) has been reported. Our aim was to compare with literature the reoperation rates and complications for various spinal procedures from a peripheral unit and to provide this information to the patients. This was a retrospective study of all patients who underwent
Objectives:. To establish the demand, referral pathways, utility and patient satisfaction of a physiotherapy led post operative
The FASTER study (Function after spinal treatment, exercise and rehabilitation) aims to evaluate, via a factorial RCT, the benefits of a rehabilitation programme and an education booklet Your back operation, . www.tso.co.uk/bookshop. , for the postoperative management of patients undergoing discectomy or lateral nerve root decompression, each compared with “usual care”. Included in this larger study is an evaluation of the booklet which forms the focus of this abstract. To date, 128 patients have been recruited into the study of which 63 have been randomised to receive the booklet. At 3 months post-surgery all of these patients are requested to complete a questionnaire on the booklet. This questionnaire contained forced-choice questions on readability etc and open questions regarding content. Finally, patients were asked their overall rating of the booklet on a scale from 1 to 10. Feedback is very positive. The average overall rating of the booklet was 8.3/10. Over 85% found it easy to read, interesting, and of appropriate length. Over 90% also stated they had learnt new and helpful information. All subjects stated that they would recommend the booklet to a friend, and the majority stated that they frequently referred to the booklet. The predominant messages received and understood by the patients were related to the safe benefits of early activation and return to normal activities. The results show that
Objective To assess the effectiveness of intrathecal fentanyl in the relief of post operative pain in patients undergoing lumbar decompression or fusion. Method 60 patients undergoing lumbar
Background. The Robotic
Objective: To assess the effect of
Preoperative autologous blood donation (PABD) is widely practised in elective orthopaedic surgery, but few data are available as regards recombinant human erythropoietin (rHuEpo) support during a PABD programme in children. In January 1999 we introduced a PABD protocol with erythropoietin (10000 U s.c. twice weekly during the 3 weeks preceding surgery) in children who were scheduled for corrective surgery of scoliosis. Between January 1999 and November 2003, 23 consecutive patients (five males and 18 females, median age 15.1 years) were enrolled. Preoperative haemoglobin (Hb) levels, the numbers of collected and of autologous and allogeneic blood transfused units were determined. The results were compared with a historical group of 28 consecutive patients (seven males and 21 females, median age 15.4 years) who underwent
There are currently no agreed guidelines for the type and frequency of post
Introduction and Aims: Incidental dural tears and cerebrospinal fluid (CSF) leaks are common complications of
Wrong-level surgery is a unique pitfall in spinal
surgery and is part of the wider field of wrong-site surgery. Wrong-site
surgery affects both patients and surgeons and has received much
media attention. We performed this systematic review to determine
the incidence and prevalence of wrong-level procedures in spinal
surgery and to identify effective prevention strategies. We retrieved
12 studies reporting the incidence or prevalence of wrong-site surgery
and that provided information about prevention strategies. Of these,
ten studies were performed on patients undergoing lumbar spine surgery
and two on patients undergoing lumbar, thoracic or cervical spine procedures.
A higher frequency of wrong-level surgery in lumbar procedures than
in cervical procedures was found. Only one study assessed preventative
strategies for wrong-site surgery, demonstrating that current site-verification protocols
did not prevent about one-third of the cases. The current literature
does not provide a definitive estimate of the occurrence of wrong-site
spinal surgery, and there is no published evidence to support the
effectiveness of site-verification protocols. Further prevention
strategies need to be developed to reduce the risk of wrong-site surgery.
As an example of benchmarking in
Introduction: Recent years have witnessed something of a paradigm shift in relation to the assessment of outcome in spine surgery: multidimensional patient-centred questionnaires have superseded the traditional surgeon-based rating of global outcome, and surgical registries have been developed to capitalise on the principle of “strength in numbers”. Interestingly, although recognised as a potential determinant of the patient’s view of the success of the surgery, the assessment of complications — in this context defined as new or unexpected problems arising as a result of surgery — has not enjoyed the same enlightened approach in relation to the patient’s perspective. The present study sought to fill this gap in the current array of outcome measures. Methods: All German-speaking patients undergoing
Psychoeducative prehabilitation to optimize surgical outcomes is relatively novel in spinal fusion surgery and, like most rehabilitation treatments, they are rarely well specified. Spinal fusion patients experience anxieties perioperatively about pain and immobility, which might prolong hospital length of stay (LOS). The aim of this prospective cohort study was to determine if a Preoperative Spinal Education (POSE) programme, specified using the Rehabilitation Treatment Specification System (RTSS) and designed to normalize expectations and reduce anxieties, was safe and reduced LOS. POSE was offered to 150 prospective patients over ten months (December 2018 to November 2019) Some chose to attend (Attend-POSE) and some did not attend (DNA-POSE). A third independent retrospective group of 150 patients (mean age 57.9 years (SD 14.8), 50.6% female) received surgery prior to POSE (pre-POSE). POSE consisted of an in-person 60-minute education with accompanying literature, specified using the RTSS as psychoeducative treatment components designed to optimize cognitive/affective representations of thoughts/feelings, and normalize anxieties about surgery and its aftermath. Across-group age, sex, median LOS, perioperative complications, and readmission rates were assessed using appropriate statistical tests.Aims
Methods
Objective: This is a prospective, randomised, double blind trial to assess the effectiveness of intrathecal fentanyl in the relief of post-operative pain in patients undergoing lumbar spine surgery. Method: 60 patients were recruited. All received our standard analgesic regime with morphine PCA via a syringe driver. They were electronically randomised to two groups – one received 15 micrograms of fentanyl intathecally; the other had nothing. The fentanyl was administered by the operating surgeon under direct vision at the end of the procedure. All patients were monitored in recovery for two hours. Visual Analogue Scale (VAS) pain scores were assessed at 2, 4, 24 and 48 hours post-op. The time to first bolus delivery of PCA was recorded as was the total amount of morphine PCA used. Both patient and assessor were blinded. Results: The patients randomised to receive fentanyl showed a significant decrease in their mean VAS pain scores for the first 24 hours. Their time to first bolus of PCA was significantly increased. They also used 40% less morphine PCA (p<
0.05 in all cases). None of the patients suffered respiratory compromise requiring treatment and they all left recovery after 2 hours to be nursed on the general ward. Conclusion: Intrathecal fentanyl is effective at reducing post-operative pain and PCA morphine use after lumbar
Objective: To evaluate a new system of prescribing and administering IV morphine introduced by our Paediatric Pain Service for paediatric patients undergoing corrective
Introduction. This study sought to determine whether the functional outcome of two common spinal operations could be improved by a programme of post-operative rehabilitation and/or an educational booklet each compared with usual care. Methods. This was a multi-centre, factorial, randomised controlled trial on the post operative management of
Objectives. To determine the limits of spinal displacement before the onset of neurophysiological changes during
To audit patient satisfaction throughout the perioperative period amongst emergency and elective admissions in the spinal team. 92 patients were identified whom underwent operations within a 3 month period using the operating database. A self administered postal questionnaire was sent to assess preoperative waiting time, quality of preoperative assessment and information given, assessment of their admission, their experience throughout hospital stay and the quality of their post operative assessment and discharge. Patient reported outcomes (PROMS) Response rate 35% (32/92) of which 24 (14F 10M) were elective admissions and 8 emergency admissions (2F 6M). Average wait for elective procedure was 5.7 weeks (median 2). 63% of elective patients were seen in prescreening clinic and 79% of these received an information booklet prior to operation. 22% of patients had delayed discharge due to non clinical causes including awaiting transport, awaiting medications and physiotherapy clearance. 88% of patients reported they were given adequate information regarding post-operative daily activities. 79% of elective patients reported seeing a doctor on the day of their discharge however only 38% reported seeing a physiotherapist postoperatively. This fell to 0% for patients operated on a Friday. Although 94% of patients reported that they were satisfied with the overall care they were given, they reported certain aspects of their clinical care being less than optimal. Trust wide assessment of patient reported outcomes to assess and improve the quality of care against national guidelines. Ethics Approval: Self questionnaire approved by ethics committee
Clinical governance encompasses audit. Audit is a requirement of our professional bodies and our hospital trusts. It is not usually resourced adequately and the ability to audit spinal surgical outcomes is haphazard nationally. This presentation describes the results that can be achieved in the absence of formal audit support. A surgical database was started in 1993; its evolution involved the use of standard outcome measures in 1995. Between 1995 and 1999, four hundred and one major spine procedures were undertaken by a single surgeon. The outcome measures were the Oswestry disability index, the low back outcome, MSP MZD and a visual analogue pain scale. Pre-operative data was collected on all 233 elective cases. Follow up was 59% at 6 months, 51% at one year and 57% at 2 years. At two years a Macnab score was available in 106 cases and the results were excellent/ good 81%, fair/poor 19%. There were 56 recorded perioperative complications. 21 occurred in the 77 instrumented procedures and 35 in the 156 non instrumented procedures. The results of this type of audit can only be cautiously compared to published data because of poor follow up. Quality outcome measures and audit probably require a funded resource to be of value.
We have examined how many and which potential complications (PCs) are recorded on the consent form by a group of consultant surgeons performing common spinal procedures - anterior cervical discectomy and fusion (ACDF) and posterior lumbar discectomy and/or medial facetectomy (PLD). Email survey Consultant spinal surgeons performing ACDF and/or PLD practicing in Southwest England Identification of the PCs each surgeon listed on the consent form for the specified procedures. There were 23 responses from 28 Consultant surgeons approached. 21 surgeons performed both ACDF and PLD, 2 performed only PLD. Surgeons quoted 5 to 17 (mode 10) PCs for ACDF and 4 to 15 (mode 13) for PLD. These did not necessarily represent the most common or most dangerous PCs recorded in the literature1,2. Small difference in PCs mentioned by Neurosurgeons and Orthopaedic surgeons was seen (ACDF mode: 12vs10, PLD mode: 12vs13). There was a strong correlation between the number of PCs recorded by surgeons for ACDF and PLD. We have found a wide variation in consenting practice amongst a group of surgeons performing common spinal operations. Issues of consent are common causes of formal complaints and potential litigation, causing anxiety for both patient and surgeon. A more homogenous consent process, employing objective measures where possible, may help reduce this burden and may be achieved by setting a national standard.