Objective. Guidelines published by the British Association of Spine Surgeons (BASS) and Society of British Neurological Surgeons (SBNS) recommend urgent MRI imaging and intervention in individuals suspected of having CES. The need for an evidence based protocol is driven by a lack of 24/7 MRI services and centralisation of neurosurgery to tertiary centres, compounded by CES's significant medico-legal implications. We conducted an audit to evaluate the pathway for suspected CES in BCUHB West between 2018 and 2021. Methods. A retrospective audit of patients managed for suspected CES between 01/11/2018 and 01/05/2021 was performed, using the SBNS/BASS guidelines as the standard. Results. A total of 252 patients received an emergency MRI for suspected CES between 2018 and 2021. 99% of patients were scanned in compliance with SBNS/BASS standards. Radiological evidence of CES was found in 18% of patients. 33% of emergency scans were performed by out-of-hours services. 4% of patients had repeated scans within the same 6-month period. The majority of referrals originated from Orthopaedics surgeons (78%), or staff in the Emergency Department (8%). 92% of ambulatory patients were not admitted to hospital. During the peak of the COVID-19 pandemic, referrals increased from 2.5 to 3.5 per week. Conclusion. SBNS/BASS standards were largely met, avoiding life changing disability and medico-legal consequences. The department should continue to follow SBNS/BASS guidance on the management of individuals with suspected CES. Challenges regarding the use of repeated scans should be addressed to avoid unnecessary costs. Introduction of new early recognition guidelines and Same Day Emergency Care (SDEC) has likely driven an increase in suspected CES referrals, and subsequent MRI demand. This audit should be utilised as an ongoing tool to ensure best practice continues, and to implement simple measures which may improve compliance with the pathway

Aims

The aim of this paper is to describe the impact of COVID-19 on spine surgery services in a district general hospital in England in order to understand the spinal service provisions that may be required during a pandemic.

Purpose of the study:. The purpose of the study was to evaluate the possible causes or risk factors for the occurrence of venous thrombotic events (VTE) after shoulder arthroscopy. Methods:. Two cases that occurred in the practice were evaluated for the study. Evaluation of their medical history, procedures and post-operative care was made. The information was evaluated for possible risk factors that could have led to the VTE. Literature reports were also evaluated. All the relevant data (personal and literature) was used to determine risk factors that could help identify high risk patients undergoing arthroscopic shoulder surgery. Results:. Results revealed no intra operative risk factors for the VTE to occur. An underlying genetic predisposition in the one case and a previous history of VTE in the other were indentified as the major risk factors/causes. Literature review revealed that underlying mechanical causes should also be considered as possible risk factors. The rate of VTE occurring after a shoulder arthroscopy (0.6/1000 procedures) is much lower than when compared to knee, hip or spinal surgery. It should be noted however that upper limb VTE's have the highest risk of a pulmonary embolus developing as compared to a lower limb VTE. Conclusion:. Surgeons performing arthroscopic shoulder surgery also run the risk of their patients developing a VTE (upper or lower limb). The attending surgeon should assess and examine their patients preoperatively with as much scrutiny as they would their patients with upcoming knee, hip or spine surgery. Surgeons should have protocols in place to identify high risk patients. These should assess extrinsic as well as intrinsic risk factors. A high index of suspicion should also be maintained in the post-operative period

Aims

The exact risk to patients undergoing surgery who develop COVID-19 is not yet fully known. This study aims to provide the current data to allow adequate consent regarding the risks of post-surgery COVID-19 infection and subsequent COVID-19-related mortality.