Posterior spinal surgery is associated with a significant amount of blood loss. The factors predisposing the patient to excessive bleeding-and therefore transfusion- are not well established nor is the effect of transfusion on the outcomes following spinal surgery. We had two goals in this study. First, we were to investigate any suspected risk factors of transfusion in posterior thoraco-lumbar fusion patients. Second, we wanted to observe the negative impact-if one existed- of transfusion on the outcomes of surgery. All adults undergoing posterior thoraco-lumbar spine fusion in our institution from May 2015 to May 2018 were included. Data collected included demographic data as well as BMI, preoperative hemoglobin, American Society of Anesthesiologists classification (ASA), delta Hemoglobin, estimated blood loss, incidence of transfusion, number of units transfused, number of levels fused, length of stay and re-admission within 30 days. The data was analyzed to correlate these variables with the frequency of transfusion and then to assess the association of adverse outcomes with transfusion. 125 patients were included in the study. Only 6 patients (4.8%) required re-admission within the first 30 days after discharge. Length of stay averaged 8.4 days (3–74). 18 patients (14.4%) required transfusion peri-operatively. When multiple variables were analyzed for any correlation, the number of levels fused, age and BMI had statistically significant correlation with the need for transfusion (P <0.005). Patients undergoing posterior thoraco-lumbar fusion are more likely to require blood transfusion if they were older, over-weight & obese or had a multi-level fusion. Receiving blood transfusion is associated with increased complication rates

Management of complex posterior malleolar fractures requires a detailed appreciation of ligamentous and bony anatomy for optimal fracture fixation and restoration of articular congruency. Pre operative planning is vitally important to determine the surgical strategy for complex ankle fractures. We evaluated pre operative planning strategy pre and post implementation of BOAST 12 guidelines (2016) focussing on pre operative CT scans prior to definitive fixation at a major trauma centre. A multi-surgeon retrospective review of prospectively collected data from 2013 to 2018 was performed at a major trauma centre. Patients who had sustained a posterior malleolar fracture and definitive fixation were identified. Information was collated from PICS, PACS, the trauma database and operative notes. 134 patients were identified over a 5 year period who had sustained a posterior malleolar fracture and had definitive fixation. (Pre BOAST guidelines = 61, Post BOAST guidelines = 73). Prior to the implementation of BOAST guidelines ¼ with posterior malleolar fractures did not have a pre operative CT scan (15/61). Post implementation of BOAST 12 90% (66/73)patients with fixation of posterior malleolus fractures had a pre operative CT scan. Posterior malleolus surgery most commonly took place In patients between 18–30 years. Following implantation of BOAST 12 guidelines there was a 15% increase in pre operative CT scanning for ‘complex ankle fractures'. Changes in national guidelines have heavily influenced pre operative planning strategy for ankle fractures at University Hospitals Birmingham. A detailed appreciation of fracture pattern pre operatively helps guide surgical strategy

Using the transverse processes of fresh porcine lumbar spines as an experimental model we evaluated the heat generated by a rotating burr of a high-speed drill in cutting the bone. The temperature at the drilled site reached 174°C with a diamond burr and 77°C with a steel burr. With water irrigation at a flow rate of 540 ml/hr an effective reduction in the temperature was achieved whereas irrigation with water at 180 ml/hr was much less effective. There was a significant negative correlation between the thickness of the residual bone and the temperature measured at its undersurface adjacent to the drilling site (p < 0.001).

Our data suggest that tissues neighbouring the drilled bone, especially nerve roots, can be damaged by the heat generated from the tip of a high-speed drill. Nerve-root palsy, one of the most common complications of cervical spinal surgery, may be caused by thermal damage to nerve roots arising in this manner.