The demand for spinal surgery and its costs have both risen over the past decade. In 2008 the aggregate hospital bill for surgical care of all spinal procedures was reported to be $33.9 billion. One key driver of rising costs is spinal implants. In 2011 our institution implemented a cost containment programme for spinal implants which was designed to reduce the prices of individual spinal implants and to reduce the inter-surgeon variation in implant costs. Between February 2012 and January 2013, our spinal surgeons performed 1493 spinal procedures using implants from eight different vendors. By applying market analysis and implant cost data from the previous year, we established references prices for each individual type of spinal implant, regardless of vendor, who were required to meet these unit prices. We found that despite the complexity of spinal surgery and the initial reluctance of vendors to reduce prices, significant savings were made to the medical centre.

Cite this article: 2015; 97-B:1102–5.

Statement of purpose

We review the current state of development of proton therapy and the implications for beam therapy in the management of primary bone tumours

Statement of purpose

We review the current state of development of proton therapy and the implications for beam therapy in the management of primary bone tumours

Determine the detection rate of modern spinal implants using the current technology.

There is a paucity of data regarding detection rates of modern spinal implants using modern walk-through pulsed archway metal detectors (AMDs). No published reports compare detection capability with hand-held metal detectors (HHMDs).

ex-vivo & in-vivo comparison of detection rates using AMD & HHMD (set to maximum DoT sensitivities), in patients of varying Body Mass Index (BMI), implants, implant mass/density and alloys.

40 patients with: lumbar disc replacement (CoCr) (n=8), cervical disc replacement (CoCr) (1), posterior deformity instrumentation (17), anterior deformity instrumentation (2), anterior reconstruction (2), PLIF (6), interspinous distraction device (1), anterior cervical plate (2) ALIF (1), All implants were titanium unless indicated. Mean metal mass was 98g (range 6g-222g).

The AMD did not detect any instrumentation individually or in combination up to a titanium mass totalling 215g. The HHMD detected all instrumentation at a distance of 5cm; with the minimum mass being 2g

No implants were detected in patients by the AMD. The HHMD did not detect any anterior lumbar or thoracic surgical implants. It detected anterior cervical implants. The HHMD detected all posterior surgical implants. There was no significant relationship between detection, BMI, total metal mass, and metal density/segment.

AMD detectors do not detect modern spinal implants. HHMD detect all modern posterior spinal implants; this has implications for patient documentation.

To determine if the use of high density implants (i.e. high proportion of pedicle screws relative to number of spinal levels involved) causes significant loss of thoracic kyphosis and its effect on sagittal balance in adolescent idiopathic scoliosis.

Retrospective analysis of pre and post-operative radiographs to assess sagittal balance and C7-L1 kyphosis angle.

17 patients (16 females, 1 male). All right sided single thoracic curves. All surgery performed by single surgeon (Senior author, ED)

Comparison of pre and post operative sagittal balance and C7-L1 kyphosis angle. Assessment of implant density (i.e. proportion of pedicle screw relative to number of spinal levels involved in correction).

9 patients demonstrated improved sagittal balance following surgery. There was no significant difference (p value 0.83) between the pre and post op C7-L1 kyphosis angle. Mean angle pre op 28.9 (95% CI 20.3 to 37.5). Mean angle post op 29.6 (95% CI 22.2 to 37.0). No correlation identified between sagittal balance correction and kyphosis angle. Metal density ranged from 79-100%.

Although the sample size in this series is modest, high density implants do not significantly affect the kyphosis angle in the operative management of adolescent idiopathic scoliosis in the thoracic spine.

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

Aim:. The aim of this study was test the amount of corrosion occurring at the (Ti) /cobalt chrome (CoCr) interface comparing this with Ti and Ti interfaces. This was compared with retrieved metal work visualised under a scanning electron microscope (SEM). Methods:. The interface of interest is the interface between rod and the screw. We investigated corrosion seen at that interface with a CoCr rod coupled to a Ti screw versus a Ti rod coupled to a Ti screw (6 screws were used) Implants were loaded according to the ASTM F2193 – 02 Standard Specifications and Test Methods for Components Used in the Surgical Fixation of the Spinal Skeletal System. Pitting potentials were monitored using cyclic potentiodynamic polarization tests (ASTM F2129 – 08 Standard Test Method for Conducting Cyclic Potentiodynamic Polarisation Measurements) to determine corrosion susceptibility. Retrieved implants were visualised under (SEM) to confirm corrosion. Results:. Mean fretting current for titanium and cobalt chrome was 7.94 (μA) and for titanium on titanium 5.89 (μA). The results of SEM showed evidence of fretting and galvanic corrosion. Discussion:. Cobalt chrome ions in hip implants have raised concern amongst the orthopaedic community. This study showed that metal ion production occurs due to fretting and galvanic corrosion. This corrosion is increased in cobalt chrome and titanium constructs but statistically more tests are required to confirm this. Further research is required to understand this interface as cobalt chrome ions pose a potential hazard to patients with their reproductive years ahead. Conflict Of Interest Statement: No conflict of interest

Aims

This study addressed two questions: first, does surgical correction of an idiopathic scoliosis increase the volume of the rib cage, and second, is it possible to evaluate the change in lung function after corrective surgery for adolescent idiopathic scoliosis (AIS) using biplanar radiographs of the ribcage with 3D reconstruction?

Aims

During revision procedures for aseptic reasons, there remains a suspicion that failure may have been the result of an undetected subclinical infection. However, there is little evidence available in the literature about unexpected positive results in presumed aseptic revision spine surgery. The aims of our study were to estimate the prevalence of unexpected positive culture using sonication and to evaluate clinical characteristics of these patients.

Aims

The aim of this study was to determine whether the sequential application of povidone iodine-alcohol (PVI) followed by chlorhexidine gluconate-alcohol (CHG) would reduce surgical wound contamination to a greater extent than PVI applied twice in patients undergoing spinal surgery.