Background. BANDAIDE aka Back and Neck Discomfort relief with Altered behaviour, Intelligent Postures, Dynamic movement and Exercises (ISBN - 0995676933) is a concise self-help booklet containing strengthening exercises and illustrated information to enable patients self-manage their back and neck pain. The aim of this preliminary audit was to determine patient opinion on BANDAIDE. Institutional audit approval was obtained – No. 8429. Methods and Results. BANDAIDE was distributed to 40 patients, who were asked to evaluate the booklet using the Usefulness Scale for Patient Information Material (USE). USE consists of nine positive statements which are subdivided into three sub-domains; cognition, emotional and behavioural. The cognition sub-domain assesses the knowledge obtained from the material, the emotional sub-domain evaluates the effects of the material on an individual's ability to cope with the illness and the behavioural sub-domain assesses ability to self-manage. Responders were required to rate the extent to which they agreed with each of the nine statements on a scale of 0 to 10, where 0 denotes ‘completely disagree’ and 10 denotes ‘completely agree’. Each subsection is on a scale of 0–30, with a higher score suggesting better usefulness. 23 participants provided their opinions of BANDAIDE through the USE. For the three sub-domains, the mean ratings for cognition, emotional and behavioural were 27.2, 24.7, and 26.4 respectively. Conclusions. This preliminary audit suggests that BANDAIDE provides coherent advice that enables a patient to self-manage their back and neck pain. Nevertheless, the opinions of a larger cohort should be pursued to obtain more robust conclusions. Conflict of Interest: George Ampat sells the BANDAIDE booklet online through Amazon and other platforms. S Rhodes and J Sims are employed by Talita Cumi Ltd, of which Bandaide is a trading name. Shantanu Kundu is a medical student and has no conflict of interest. Sources of funding: No funding was obtained

Background. Cauda equina syndrome (CES) is a spinal condition requiring emergency spinal surgery once diagnosed. The patient-reported symptoms are often subtle and none have been shown to be sensitive or specific in confirming CES. Magnetic resonance image (MRI) is the diagnostic gold standard, and guidelines recommend MRI access within 24-hours of symptom presentation. Limited sequence MRI scans (sagittal T2 sequences of the whole spine) have been shown to successfully identify patients with scan-positive CES despite reducing the duration of an MRI. The aim of this audit was to examine utilisation of same-day MRI requests by spinal practitioners from a newly operational same-day emergency care spinal unit over the two-year period. Methods and results. Data was routinely collected over the two-year period and retrospectively reviewed. Data extraction occurred for cases of suspected CES with a same-day scan. Data extraction included type of MRI scan (lumbar/ whole spine/ CES protocol); outcome (admission/ discharge); final diagnosis. After clinical examination, only 258 (24% of 1085) suspected CES cases were identified and scanned within 24 hours, 58% (n=149) of which were with CES limited sequence scans. Only 12% (n=30) demonstrated scan- positive CES resulting in surgery within 24-hours. MRI same-day requests increased between 2020 (n=81, 21%) and 2021 (n=177, 26%), although utilisation of limited sequence scans improved (n=39, 48% in 2020; n=109, 62% in 2021). Conclusion. Limited sequence MRI scans are a time- and cost-saving means of providing screening for those with suspected CES. Improved utility was demonstrated over the 2-year period by the spinal practitioners. Conflicts of interest: No conflicts of interest. Sources of funding: No sources of funding

Purpose of the study and background. This audit report outlines a physiotherapy lead spinal triage program for inpatients in a private hospital. The reason to trial this model was proposed as a way to expedite the assessment of inpatients presenting with back pain and implement an appropriate and prompt management plan. Summary of the methods used and the results. An audit tool was developed to record the patient details and outcomes of referrals to the spinal triage program. Length of time between referral and triage was recorded as was the number of patients that went on to require a spinal surgeon consult and spinal intervention. A total of 75 patients were referred into Spinal Triage over a 7 month period. The majority of in patients referred for spinal consult within this private hospital setting were triaged solely by physiotherapy (56%) and a management plan decided on in conjunction with the spinal surgeon on call who could access any imaging remotely. Six patients (8%) involved in the triage program went on to have spinal surgical intervention. Conclusion. Results indicate that the majority of spinal consults at inpatient level do not proceed to require surgical intervention. These results support the model of using Physiotherapists to triage this patient group. I can confirm that this abstract has not previously been published in whole or substantial part nor has it been presented previously at a national meeting. Conflicts of interest: No conflicts of interest. Source of funding: No funding obtained

Aim. NICE guidance on lumbar total disc replacement (TDR) recommends ongoing audit should be an integral part of disc replacement surgery. We present our ongoing audit data and the extent of problem of patients lost to follow up. Method. 35 patients underwent lumbar TDR surgery over 4.5 years. They were followed prospectively. A database is maintained and ODI and VAS were collected prospectively, including patient satisfaction and any failures. Results. At latest follow up full data was available for 30 out of 35 patients. The mean follow-up was 34 months (range 3-52 months). There were 13 males with a mean age 37.7 years (range 27-62) and 17 females with a mean age of 49.8 years (range 27-62). Surgery was single level in 24 cases and double level in 6 cases. 21 patients rated their outcome as good or very good and 7 as unsatisfactory. There were 2 failures, one secondary to late extrusion of the polyethylene liner (12 months post-surgery) and one early anterior migration of the prosthesis. ODI scores improved by a mean of 28 points (range -4 to 68) whilst VAB scores improved by a mean of 4.9 (range -1 to 9). Five patients had been lost to follow up. One patient migrated out of the area. Two came from out of the area and did not return for follow up after the initial period and two further patients DNAed multiple clinic appointments. Conclusion. We conclude that lumbar disc replacement surgery can provide substantial improvement in pain relief and function. Continued audit of this cohort of patients is essential to comply with NICE guidance. 14% loss to follow up/audit is encountered despite our best effort

To evaluate the patient experience of patients referred to the ESP Orthopaedic Triage Service. To identify the demographic data of the patients. To evaluate patients' expectations and satisfaction of the service. A prospective audit of 50 new patients to the ESP service in Mountain Ash General Hospital and Prince Charles Hospital. The audit was carried out over a 3 month period between December 2008 and February 2009. Patients were asked to anonymously complete a survey following their appointment. Data was collated independently and analysed with descriptive statistics. Patients referred to ESP service. Self administered satisfaction survey. Mean age range 40-59 yrs (range 20 -70yrs). 50% >1 year duration of symptoms. 94% of patient's surveyed rated the service provided as good - excellent. 88% of patient's reported that they were happy to be assessed by the ESP. 96% of patients surveyed agreed they were able to discuss their treatment openly with only 10% preferring to see a Doctor. The ESP service in Cwm Taff Health board achieves a high level of patient satisfaction

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). Results/Summary. Patients were asked 17 questions in total, 3 general, 6 regarding CNS and 8 regarding OT. The responses were rated ‘very good’; ‘good’ ‘average; ‘poor’. In the returned audits no ‘poor’ responses were recorded. Clarity of information given: Very Good-56%; Good-39%; Average-5%. Overall experience of pre-operative assessment: Very Good-66%; Good- 32%; Average-2%. Advice given by OT: Very Good-82%; Good-16%; Average-2%. Information given by CNS: Very Good-75%; Good-23%; Average-2%. Conclusions. The results indicate that the OT and CNS specialist education sessions are considered valuable by patients. We believe that we have achieved this through good team-working in a multidisciplinary setting. Patients who attend these clinics are often anxious regarding surgery, have un-realistic expectations in relation to what to expect post-operatively. A significant number of our patients are elderly and have multiple pathologies which we take into account. The education sessions link into our patient information leaflets which, expand on this allowing patients to clarify matters and ask questions. No Conflicts of Interest. No Funding Obtained

Patients with peripheral primary bone tumours are often identified and referred at an early stage to a regional tumour service according to established guidelines. In patients with primary bone tumours of the spine, however, the definitive management or outcome of such patients is being prejudiced by preliminary intervention from non-specialist services prior to their referral. Objective: To audit the standards of management of patients with primary bone tumours of the spine referred to a regional tumour service. Retrospective review of case notes and radiology. Subjects: Patients with primary bone tumour of the spine managed at the Orthopaedic Spine Unit with the Regional Bone Tumour Service in Newcastle Upon Tyne Hospitals NHS Trust. Referral to tumour service, prior intervention, operative treatment, survival, factors affecting definitive management. 31 of 39 (16 benign, 23 malignant) patients were initially referred from primary care to services other than the regional tumour service, most commonly neurosurgery (11/39) and paediatric oncology (4/39). Seven of 39 of these patients had undergone interventions prior to their referral to the tumour service, which may have negatively impacted their definitive management or curative surgery. These tumours present complex issues regarding their definitive management to optimise outcome. Closer links between departments are required to enable the multidisciplinary management of primary bone tumours of the spine. Prior surgical intervention may compromise cure. Those involved in their management should be encouraged to liaise with their regional bone tumour service to improve outcome

In major procedures like scoliosis surgery, parents are often asked to sign the consent on behalf of children because of the pretext that minor may have limited understanding and judgement about the procedure. Scoliosis surgery for patients with AIS is mainly indicated for cosmetic or psychological reasons. We audited our practice in the department to collect information on the current consent practices involving the minor patients undergoing scoliosis surgery. We also have conducted a questionnaire survey of the various spinal units in UK to assess their practice in this regard. Forty-two consent forms (28 patients; multiple procedures in some patients) and case notes of patients between 12 and 16 years undergoing scoliosis surgery were reviewed. We have contacted 12 spinal deformity correction units and 11 spinal trauma units across UK over telephone to assess the current consenting practice as well. 9.5% (n=4) patients signed there own consent forms. Except in one case explanation of risks were documented in detail. Except two units (18%) offering the minor patient to sign their consent, parents are usually asked to sign consent on their behalf in majority (10/12) units. Seven out of the twelve spinal units use standard NHS or department of health consent forms. Few units have their own consent form with some alterations or additions. There is no specific age when a child becomes competent to consent to treatment: It depends both on the child and on the seriousness and complexity of the treatment being proposed. However, it is still good practice to encourage competent children to more involved along with their families in decision-making

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. Results. From Nov 2013 till April 2014, 177 patients (48 Male: 119 Females) with an average age of 50 (17–95) years were referred to OSRAS. Wednesday was the busiest day with 26% referral in AM and 74% in PM. Main source of referrals were: Regional MSK services (50), Triage (34), ED (27) and GPs (20). The reasons were: suspected CESI (n=100), Acute LBP (n=30), pathological fractures (n=23), progressive neurology (n=16), discitis (n=5) and spinal stenosis (n=2). Depending on clinical need 29 patients were seen on same day, 33 next day, 53 with in 2–5 days and 31 more than 5 days. Eighty patients were discharged, 36 listed for surgery, 27 required further follow up and 31 were given telephone advise only. High user satisfaction rating was obtained. Conclusion. We propose an OSRAS model as an alternate to often un satisfactory current emergency department model, that can provide a structured pathway for timely expert management of serious spinal pathologies therefore prevent potential consequences whilst avoid unnecessary admissions. Conflicts of interest: No conflicts of interest. Sources of funding: No funding obtained

Introduction. The British Scoliosis Society published a document in 2008 which set out the minimum standards for paediatric spinal deformity services to achieve over a period of time. But how do the UK paediatric spinal deformity centres measure up to these benchmarks?. Methods. We performed a telephonic survey, contacting every UK spinal deformity centre. The questionnaire probed how each unit compared to the recommended standards. Results. Twenty three centres were interviewed, covering 81 surgeons in total (range 1-8 surgeons per centre). Four centres (17%) did not have 24-hour access to a MRI scanner and all but 2 centres had on-site facilities for long-cassette films/scoliograms. Five centres (22%) always had 2 consultant surgeons per case, 9 centres (39%) routinely have only 1 consultant surgeon per case, and the rest had 1 or 2 consultant surgeons depending on seniority. Six centres (26%) did not routinely have shared care of their patients with the paediatric team. All centres used intra-operative SSEP monitoring, a minority used MEP monitoring (34%), and all but 2 centres had either direct or indirect supervision by a consultant neurophysiologist. All centres have cell saver units available with over half using them routinely (14/23). None of the centres used routine chemoprophylaxis. All units used thromboembolic stockings, with five centres (22%) routinely using foot pumps. Nineteen centres (83%) routinely sent their spinal deformity patients to ITU/PICU postoperatively. Our survey also asked each center what supporting facilities were available, whether they ran adolescent clinics, and whether they participate in multi-disciplinary meetings and audit. In addition, we questioned what typed of drains each center used and the length of time that patients were followed-up. Conclusion. This survey shows how the UK spinal deformity units stand up against the BSS standards, provides an insight in to current UK practice and highlights areas for improvement

Spinal cord injury following trauma is initially dealt with by acute hospitals. The early management including stabilization is usually performed by these centres. This is followed by onward referral to one of the Regional Spinal Injury Units. There is concern of both sides of the fence regarding mobilization following spinal cord injury. The acute hospitals want to avoid the problems of prolonged recumbency and the Regional Spinal Injury Units wish to avoid the problems of early aggressive mobilization. Therefore, we set out to discover if there was a standard approach to mobilising these patients following surgical stabilization, because of the oversubscribed resources of the spinal injury units and the wish to start mobilizing the injured as soon as possible. A comparative audit of the Regional Spinal Injury Units in the UK and North American Units. Regional Spinal Injury Units in United Kingdom and North America. Clear Management Plan. Mobilisation Schedule. We had replies from all Regional Spinal Injury Units in the UK and from seven in North America. The Regional Spinal Injury Units all had differing approaches. Only a few were able to convey a clear management plan and mobilization schedule. Whereas the North American Units provided a ‘mobilize as able’ plan in all cases. The North American Units had a ‘mobilize as able’ policy, whereas the UK units had a mixed approach. A coherent collaboration between the spinal surgeons stabilizing these injuries and the spinal injury units providing rehabilitation would improve patient management

Purpose. To compare the incidence and nature of ‘neurophysiological events’ identified, post hoc, by a consultant neurophysiologist with those identified intra-operatively by clinical physiologists, before and after intervention(s). Methods. The IOM wave-recordings, event-logs and reports of all spinal deformity cases conducted by a team of clinical physiologists from April to June 2009 (Group 1) were reviewed retrospectively by the same, experienced clinical neurophysiologist, (MG). Interventions were then agreed. The first was to alter the IOM report document to drop down menus. The second was to arrange a series of teaching sessions for the clinical physiologists on a variety of aspects of IOM. Finally during these teaching sessions recent cases were brought to review in an informal setting to discuss. Following implementation of the interventions a further review from April to June 2010 (Group 2) was carried out in the same manner. The clinical physiologists did not know the time periods over which the review would be taking place. Results. From April to June 2009 (Group 1) thirty two patients were studied and from April to June 2010 (Group 2) thirty four patients were studies. Group 1. Twenty seven of these had been monitored using ‘multimodal’ IOM consisting of cortical (CSEP) and spinal (SSEP) somatosensory evoked potentials and motor (MEP/CMAP) evoked potentials. Two patients were inappropriate for MEP recording and two were monitored using epidural SSEP recording. During 10 operations (31%) the surgeons were notified of an ‘intra-operative neurological event’ judged by the clinical neurophysiologist as potentially requiring a surgical response. When the results were audited, only 2 (6%) of these ‘events’ were considered by the consultant clinical neurophysiologist to represent ‘true positive’ intra-operative neurophysiological findings. Group 2. Twenty six of these had been monitored using ‘multimodal’ IOM consisting of cortical (CSEP) and spinal (SSEP) somatosensory evoked potentials and motor (MEP/CMAP) evoked potentials. Four patients were inappropriate for MEP recording and had a combination of SSEP and CSEP. The remainder had IOM with unimodal. No epidural IOM was used during this period. During 4 operations (12%) the surgeons were notified of an ‘intra-operative neurological event’ judged by the clinical neurophysiologist as potentially requiring a surgical response. Post-operative examination of all the patients in both groups revealed that no ‘false negative’ conclusions had been reached. Conclusion. In this series clinical physiologists were found to alert the surgeons 5 times more frequently than was likely to have been the case with an experienced consultant clinical neurophysiologist (31% and 6% respectively). However the increased reporting of intra-operative events did not result in any alteration of the ultimate surgical strategy in any operation although tactical changes were sometimes necessary during the operation in order to test the reversibility of the flagged event. The implementation of two simple interventions resulted in the clinical physiologists alerting the surgeons only 1/3 of that previously (12%) of cases. The log indicated that on all occasions appropriate surgical action had been taken with no residual neurological deficit. This study, owing to its size, cannot answer the key question of safety. Further work to estimate the statistical power required of such a study is being sought. In the interim proving a track record of successful cases provides evidence of efficacy. Ethics Approval: None. Interest Statement: None

Spondylodiscitis is an uncommon condition with an incidence of 1:100,000 to 1:250,000 in developed countries. Diagnosis and treatment can be delayed resulting in poor outcomes. A high index of suspicion is necessary considering the associated mortality, reported at 2–17%.

Establishing a diagnosis can be challenging as features are non-specific and onset may be insidious. While treatment is usually conservative, certain situations require surgery. All patients however require careful assessment and monitoring for complications that may require further intervention. A review of our practice in Wexham Park and Heatherwood Hospital NHS Trust from 2009 to 2013 produced a guideline suggesting the need for blood cultures, imaging with MRI and involvement of the infectious diseases and spinal teams. We re-audited (20 cases) to assess compliance with the guidelines, which were in place to reduce the delay in diagnosis.

Recurrent presentation, infections of unknown origin and deterioration after a short course of antibiotics were indicators for triggering imaging of the spine for discitis. Delays in diagnosis were more marked in bacterial cases rather than tuberculosis. It was impossible to predetermine patients that would require surgical intervention. Our compliance with the guideline had improved from 70 to over 90% and there were no relapses or mortality.

To assess concordance between hospital coding and clinician coding for patients undergoing spinal instrumentation procedures and determine if our coding systems result in accurate financial reimbursement from the primary care trust (PCT).

We conducted a one year retrospective review of 41 patients who underwent spinal instrumentation procedures. Data collected from IT systems included: operation description, clinician procedure code, hospital procedure code, Hospital Health Resource grouping (HRG), clinician HRG, instrumentation costs and PCT reimbursement fees. From this data we compared coding based re-imbursement fees and actual surgical costs, taking into account exact instrumentation prices.

In all cases the primary hospital and clinician coding values differed. Using the clinician code would have altered the HRG group in 16 patients. Using solely clinician coding would have generated less financial reimbursement than using hospital coding.

In 23 patients undergoing complex spinal procedures, instrumentation costs represented a significant proportion of the final fee obtained from the PCT, thus leaving a small proportion for the associated hospital stay costs. This suggests instrumentation costs are inadequately reimbursed from the PCT.

Hospital coding appears more accurate than clinician coding and results in greater financial reimbursement. On the whole, we found there to be insufficient reimbursement from the PCT. The variable and sometimes substantial cost of spinal instrumentation procedures results in inadequate reimbursement for many procedures. We feel the payment by results (PBR) scheme is suboptimal for such procedures and adequate reimbursement can only be achieved by direct billing on an individual case basis.

Aim

To assess whether oncologists are adhering to the NICE guidelines on MSCC.

Aim

To identify patterns in referral and the management pathway of patients with primary bone tumours of the spine referred to the Orthopaedic Spine Unit in order to recommend ways to improve the service.

To review our practice of requesting nerve root blocks, to see how effective our therapeutic blocks are and how many of our diagnostic blocks confirm clinical suspicion and help decision making.

Retrospective cohort analysis

120 fluoroscopically guided nerve root blocks were performed between 20/08/2008 and 29/12/2008. There were 100 patients who had pain diary data available, 42 males (mean age 52.02 range 20-76) 58 females (mean age 60.03, range 22-88).

We recorded: clinical diagnosis, reason for block, result of block on a 10 point visual analogue pain diary on days 0, 2, 14 and at review. A successful block was defined as an improvement of at least 2 points. For the diagnostic blocks we also recorded whether the block result influenced surgical decision making.

Block methods will be illustrated in diagram. Results will be displayed graphically and in text. 18 blocks were cervical (1 purely diagnostic, 6 therapeutic, and 10 mixed, 1 data unavailable). 71 blocks were lumbar (1 purely diagnostic, 28 purely therapeutic, and 37 mixed, 5 data unavailable). 28% of all blocks were successful immediately (2 unavailable data) and 22% at two weeks (1 unavailable data). By 3 months the success rate for therapeutic blocks was 26%. Of the blocks done for diagnostic reasons, 86% influenced a clinical decision at the next outpatient appointment.

Our results justify the continuance of this service. Increased care should be taken that patients' outcome data is collected.

Background. Free From Pain (aka Fear Reduction, Exercise Early with Food from plants, Rest and relaxation, Organisation and Motivation to decrease Pain from Arthritis and Increase Natural Strength) is a functional rehabilitation programme to combat sarcopenia and musculoskeletal pain in seniors. It is also published as a book (ISBN-0995676941). The aim of this audit was to evaluate the safety and suitability of the exercises and the usefulness of the exercise book. Methods and Results. Participants were volunteers who paid to attend the Free From Pain Exercise programme. Participants evaluated the exercises using a 5-point Likert scale and the Exercise Book using the Usefulness Scale for Patient Information Material (USE). 30 participants attended the Free From Pain programme. 26 participants completed the questionnaire. This included 20 females and 6 males, with a mean age of 76 years. The mean scores on the 0 to 5 Likert scales were A) Exercises were suitable? 4.69; B) Exercises were safe? 4.58; C) Absence of any injury or medical event whilst exercising? 4.58; D) Covered all body parts? 4.38; E) Easy to do at home? 4.42; F) Encouraged to do more exercise? 4.42; G) Recommend to family and friends? 4.50. The mean scores of the cognitive, emotional, and behavioural sub domains of the USE scale, scored 0 to 30, were 25.23, 23.73 and 23.69, respectively. Conclusion. The pre-pilot study suggests that the suggested exercises are safe and suitable for seniors, and that the exercise book is holistically useful. Conflict of Interest: G Ampat sells the Free From Pain Exercise book online through Amazon and other platforms. S Rhodes and J Sims are employed by Talita Cumi Ltd, of which Free From Pain is a trading name. Jacqueline Howard is a medical student and has no conflict of interest. Sources of funding: No funding was obtained

Introduction. The British Spinal Registry (BSR) is a web-based database commissioned by the British Association of Spine Surgeons (BASS) in the UK. It allows auditing of spinal surgery outcomes, patient's safety and overall experience. The clinical data include patient's demographics which is entered into the Registry by medical staff, as well as patient-reported outcome measures (PROM) that is submitted to the Registry by the patient themselves at different time periods post-operatively. It has the ability to register Device and Implants as well as co-ordinate multicentre research. This study is to identify both the staff and patient compliance regarding to data submissions to the BSR at St. George's Hospital NHS Trust. Methods and Materials. Retrospective analysis of the BSR data for all spinal surgeries that was performed at SGH by the three Complex Spinal Surgery Consultants between 1st January 2017 to 31st December 2018. This study period allowed up to 12 months PROM data analysis. Staff and Patient compliance were analysed separately depend on the data they submitted. Results. 404 (n) spinal surgeries were performed over this two-year period. Surgical demographics: 39.4% (159/404) males and 56.2% (227/404) females, 4.5% (18/404) declined to be added. Age ranging from 6 to 92, mean age was 47.9. Staff compliance was 89.4% for the registration of patient data. Trauma and tumour patients were excluded as they are not required to complete any pre-operative PROMs. For the remaining patients, 35.8% (116/324) completed their baseline pre-operative PROMs. A steady decrease in patient compliance for post-operative PROMS was observed: 29.8% (2 weeks), 24.9% (6 weeks), 21.2% (6 months), 17.1% (12 months), and 16.6% (24 months). Conclusions. We identified a poor patient compliance in both pre-operative and post-operative PROMS. Patient questionnaire fatigue can occur over time which results in falling compliance to PROMS in 12 months and 24 months. Moreover, patients who do not provide an email address are less likely to fill in their PROMS. Satisfactory compliance for staff regarding to BSR utilisation are shown. Staff should aim to achieve a higher level of compliance as this will help to keep a record of all spinal surgeries that are performed and any complications that are encountered in a particular centre. Over the past three years, the BSR had introduced various schemes to drive up utilisation including a Best Practice Tariff in 2019. Part of the tariff will be withheld when staff failure to enter patients onto the Registry. Further research is needed to determine why there is such fall off especially with patient compliance and to elucidate potential measures to improve their compliance

Introduction. Pulmonary Tuberculosis (TB) can be detected by sputum cultures. However, Extra Pulmonary Spinal Tuberculosis (EPSTB), diagnosis is challenging as it relies on retrieving a sample. It is usually discovered in the late stages of presentation due to its slow onset and vague early presentation. Difficulty in detecting Mycobacterium Tuberculosis bacteria from specimens is well documented and therefore often leads to culture negative results. Diagnostic imaging is helpful to initiate empirical therapy, but growing incidence of multidrug resistant TB adds further challenges. Methods. A retrospective analysis of cases from the Infectious Disease (ID) database with Extra Pulmonary Tuberculosis (EPTB) between 1. st. of January 2015 to 31. st. of January. Two groups were compared 1) Culture Negative TB (CNTB) and 2) Culture Positive TB (CPTB). Audit number was. Results. 31 cases were identified with EPSTB. 68% (n=21) were male. 55% (n=17) patients were Asian, (19% (n=6) were black and 16% (n=5) were of white ethnicity. 90.4% (n=28) patients presented with isolated spinal TB symptoms. No patient had evidence of HBV/HCV/HIV infections. CPTB Group was 51.6% (n=16) compared to CNTB Group with 48.4% (n=15) 48% (15) lumbar involvement, 42% (13) thoracic and 10% (3) cervical. 38.7% (12) patients presented with late neurology, equally in both groups. 56% CPTB patients showed signs of vertebral involvement on plain radiograph compared to 13.3% in CNTB patients. 68.7% CPTB patients had pathological changes or paraspinal collections seen on CT scan compared to 53.3% of CNTB patients. 81% of CPTB showed positive MRI findings compared to 86% in CNTB. Both groups were treated with Anti-TB medications according to local guidelines. 83% patients were followed up till the end of the treatment course. 22.5% (n=7) patients had Ultrasound guided aspiration. 29% (n=9) patients underwent surgical intervention. 3 patients had Laminectomy for decompression. 6 patients underwent Spinal Decompression and Fixation due to extensive bone destruction. No mortality occurred. Conclusion. TB continues to be a growing problem in the developed world with high numbers of patients travelling from endemic regions. 75% of our cases were from Asian or Black ethnicity. The thoracolumbar region was most commonly effected (90%). Approximately 50% of cases of extrapulmonary spinal TB were culture negative. Neurological deficit occurred in 40% patients and 30% of patients required surgery. Standard anti-TB treatment was however effective in all cases with no significant drug resistant variants noted. MRI and CT imaging remain the superior diagnostic tests in the presence of high CN EPSTB