To evaluate the prevalence of infection after elective spinal surgery, a prospective study of patients was carried out over 10 years to 2002. Demographic details, diagnosis and indications for surgery, duration of surgery, time delay before surgery and concomitant diseases were recorded. The management and outcome of patients who developed infection postoperatively were noted. During the period, 1050 elective cases were done for scoliosis, tuberculous spine, tumours, trauma, biopsy and degenerative disorders. There were four deep and six superficial infections. Deep infections were treated by debridement and implant removal, with good outcomes. Superficial sepsis settled with local therapy. The rate of sepsis following elective spinal surgery was 0.95% and infections responded well to treatment

To review blood transfusion practices during elective spinal surgery procedures. Prospective clinical audit. All patients who underwent elective spinal surgery between January 2009 and March 2009. Crossmatch: Transfusion ratio (C: T ratio); Transfusion index (TI) (Evaluates cost-effective crossmatch). British Haematological society standards are C:T ratio= 2.5:1 and TI>0.5. Data was collected from electronic records of blood bank, pathology system (NOTIS) and review of patient notes. A total of 194 patients underwent elective spinal surgery in our unit. (Cervical spine = 15, Thoracic spine = 3, Vertebroplasty = 10, Lumbar spine = 142, Deformity = 31, other = 8). Of these, 62 patients had 197 blood products crossmatched but only 37 units were used. C:T ratio in lumbar spine surgery was 22:1. However C: T ratio in cervical spine procedures, thoracic spine and deformity correction were 6:1, 11:0 and 4:1 respectively. TI was <0.5 in all procedures except deformity surgery (TI=1). Over- ordering of blood products is still common in spinal surgery as routine blood transfusion may not be required in most elective procedures. Therefore implementing Electronic Issue (EI) of blood products for elective spinal procedures for non deformity procedures can be a cost effective and safe practice

Aim

To investigate the role of websites in enhancing patients' understanding of reason and risk of surgery as a part of informed consent for elective un-instrumented lumbar spine surgery (EULSS).

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 spinal surgery during the pandemic. Methods. A prospective observational study was conducted from eight spinal centres for the first month of operating following restoration of elective spine surgery in each individual unit. Primary outcome measure was the 30-day postoperative COVID-19 infection rate. Secondary outcomes analyzed were the 30-day mortality rate, surgical adverse events, medical complications, and length of inpatient stay. Results. In all, 257 patients (128 males) with a median age of 54 years (2 to 88) formed the study cohort. The mean number of procedures performed from each unit was 32 (16 to 101), with 118 procedures (46%) done as category three prioritization level. The majority of patients (87%) were low-medium “risk stratification” category and the mean length of hospital stay was 5.2 days. None of the patients were diagnosed with COVID-19 infection, nor was there any mortality related to COVID-19 during the 30-day follow-up period, with 25 patients (10%) having been tested for symptoms. Overall, 32 patients (12%) developed a total of 34 complications, with the majority (19/34) being grade 1 to 2 Clavien-Dindo classification of surgical complications. No patient required postoperative care in an intensive care setting for any unexpected complication. Conclusion. This study shows that safe and effective planned spinal surgical services can be restored avoiding viral transmission, with diligent adherence to national guidelines and COVID-19-secure pathways tailored according to the resources of the individual spinal units. Cite this article: Bone Jt Open 2021;2(12):1096–1101

Aims. To evaluate the incidence of primary venous thromboembolism (VTE), epidural haematoma, surgical site infection (SSI), and 90-day mortality after elective spinal surgery, and the effect of two protocols for prophylaxis. Patients and Methods. A total of 2181 adults underwent 2366 elective spinal procedures between January 2007 and January 2012. All patients wore anti-embolic stockings, mobilised early and were kept adequately hydrated. In addition, 29% (689) of these were given low molecular weight heparin (LMWH) while in hospital. SSI surveillance was undertaken using the Centers for Disease Control and Prevention criteria. Results. In patients who only received mechanical prophylaxis, the incidence of VTE was 0.59% and that of SSI 2.1%. In patients who were additionally given LMWH, the incidence of VTE was 0% and that of SSI 0.7%. The unadjusted p-value was 0.04 for VTE and 0.01 for SSI. There were no cases of epidural haematoma or 90-day mortality in either group. When adjusted for case-mix, LMWH remained a significant factor (p = 0.006) for VTE, but not for SSI. Conclusion. A peri-operative protocol involving mechanical anti-embolism stockings, adequate hydration, and early post-operative mobilisation is effective in significantly reducing the incidence of VTE. The addition of LMWH is safe in patients at higher risk of developing VTE. Cite this article: Bone Joint J 2017;99-B:1204–9

Study design: Prospective longitudinal cohort study with two-year follow up. Objective: To define the standard outcome measures that describe a patient’s subjective outcome following elective spinal surgery. What constitutes a clinically important change in outcome is not well understood and few studies have addressed this issue. Subjects: 193 patients undergoing elective spinal surgery (110 discectomy, 72 spinal decompressions and 11 other procedures) Average age 48 years. Outcome measures: Oswestry disability index (ODI), Low back outcome score (LBO), Visual analogue score (VAS) and patient subjective assessment of outcome as Excellent, Good, Fair and Poor. Results: There were 100 Excellent results, ODI 54 pre and 19 post. 62 Good results ODI 53 pre and 29 post. The 18 Fair results started with an ODI of 63 and improved to 51. The 13 Poor results started with an ODI of 66 and ended with 61. Similar changes occurred in VAS and Low back outcome score. An excellent outcome for discetomy, ODI reducing from 57 to 13 was different to an excellent outcome for a decompression, where the ODI changed from 54 to 26. Conclusion: Generic spinal outcome scores are the current measurement tool of clinical change. Clinically significant change as perceived by the patient may be different for different conditions. Only a Poor outcome was associated with an ODI change of less than 10 points

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 spinal surgery. NICE guidelines exist for VTE prophylaxis but do not specifically address spinal surgery. In addition, the ruling of the UK Supreme Court in 2015 resulted in new guidance on consent being published by the Royal College of Surgeons of England (RCSEng). This study assesses our compliance in antibiotic, VTE prophylaxis and consent in spinal surgery against both US and UK standards. Methods. Retrospective review of spinal operations performed between August and December 2016. Case notes, consent forms and operation notes were analysed for consent, peri-operative antibiotic prescribing and post-operative VTE instructions. Results. Four Spinal surgeons performed 45 operations during this period. 31 patients (69%) received a copy of the signed consent with this process being formally documented in 22 (71%) of those cases. All patients were consented by a competent surgeon. 82% of cases consented prior to the date of procedure were countersigned on the day of operation. There was a mean time of 25.3 days between initial consent and operation (Range: 0–170). 37 (82%) cases had clear instructions for VTE and antibiotic prophylaxis. All prescribed post-operative antibiotics were administered. Discussion. The North American Guidelines state that prophylactic antibiotic is appropriate in all spinal surgery with prolonged cases requiring intraoperative re-dosing and only complex cases needing a postoperative regimen. Eight patients underwent a complex procedure and 7 appropriately received postoperative antibiotics. Of the 29 patients that underwent a simple procedure, 12 did not receive post-operative regimen, in line with the guidelines. However, the remainder 17 were over treated. The US Guidelines recommend mechanical VTE prophylaxis only in elective spinal surgery except in high risk patients. All our patients received VTE mechanical prophylaxis. RCSEng guidelines require consent being taken prior to procedure by a competent surgeon and confirmed on day of procedure. All patients in our cohort were consented prior to the date of operation allowing time for considering options and independent research. 82% of patients had consent confirmed on day of operation. Conclusion. This study demonstrates that we met guideline advice for all patients with regards VTE prophylaxis. We have a tendency to over treat with post-operative antibiotics and not all patients had their consent confirmed on day of procedure but was consented well before day of operation. North America still lead the way with guidelines on spinal surgery to which we should adhere, with NICE guidelines providing limited instructions. New consenting guidelines from RCSEng may not be currently widely known and thus should be a source of education for all surgeons

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

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 spinal surgery, vary depending on the surgical intervention and their method of calculation and secondly, to assess whether there is any correlation between the two external anchors most frequently used to calculate the MCID. . We carried out a retrospective analysis of prospectively gathered data of adult patients who underwent elective spinal surgery between 1994 and 2009. A total of 244 patients were included. There were 125 men and 119 women with a mean age of 54 years (16 to 84); the mean follow-up was 62 months (6 to 199) The MCID was calculated using three previously published methods. Our results show that the value of the MCID varies considerably with the operation and its method of calculation. There was good correlation between the two external anchors. The global outcome tool correlated significantly better. We conclude that consensus needs to be reached on the best method of calculating the MCID. This then needs to be defined for each spinal procedure. Using a blanket value for the MCID for all spinal procedures should be avoided. Cite this article: Bone Joint J 2015;97-B:366–71

Background. Surgical patients have cost the NHS 1.3 billion GBP from 1995. Spinal pathologies can present diagnostic challenges, and the consequences of delayed diagnosis or surgical complications can be devastating and so creating high indemnity costs. We aim to highlight the spinal associated litigation patterns within the United Kingdom. Method. Data was obtained from the NHS Litigation Authority from 2002 to 2010. Result. From 236 claims, 144 were related to trauma or acute diagnostic issues and 92 from elective surgery. The financial burden to the NHS came to 60.5 million GBP. Of this sum 42.8 million GBP were paid in damages, and the remaining 29% in legal costs. The financial costs were similar for trauma and elective cases. The most frequent cause of successful litigation for trauma were, missed fractures(41.7%), missed cauda equina(23.6%) and spinal infection(11.8%). The emergency department(43.8%), orthopaedic surgery(28.5%) and Medicine(13.9%) bore the brunt of the claims. For elective surgery, Spinal Damage(19.8%), failure in Post-Operative Care(15.4%), Infection(11%) and Wrong Level Surgery, Cauda Equina and Surgical Failure(9.9% each). were likely to result in a successful claim, and the litigation burden was felt by the orthopaedic(60.4%), Neurosurgery(18.7%) and other surgical disciplines(11%). Conclusion. Acute spinal fractures, cord compression and infection should be considered in patients in the emergency department setting, with appropriate examination and investigations for uncertainty. A lack of awareness of at risk cases increases the likelihood of a pay-out and sums involved. For elective spinal surgery, a failure in the consenting process and the technical skill of the surgeon are likely to result in a pay-out. A failure to identify post-operative complications such as infection and thromboembolism are also indefensible. Protecting patients intra-operatively and maintaining high technical expertise and vigilance post-operatively in an adequately consented patient may decrease litigation rates

The use of blood transfusion in elective spinal surgery still remains a topic of debate in spite of several guidelines on transfusion in orthopaedic surgery. We report on a study done to look at the transfusion practice in 64 patients who underwent scoliosis correction surgery in our institution. There were 16 males and 48 females, with an average age of 19.8 years (range 3–70 years). There were 50 patients with idiopathic scoliosis, seven with degenerative scoliosis, five with neuromuscular scoliosis, and one each of congenital and neurologic scolioses. 31 of the patients underwent posterior correction and 13 patients underwent anterior surgery and 11 patients underwent posterior surgery with costoplasty and 5 patients underwent front and back surgery while 4 patients had front and back surgery with costoplasty. 10 patients underwent iliac crest bone grafting. The mean preop haemoglobin was 13.1 g % (range11.3–16.2 g %) and the mean postop haemoglobin was 8.9 g % (5–14.9 g %). The average amount of intraoperative fluids infused was 4100 ml (range: 300–11000 ml). The mean blood loss was 803.3 ml (range: 300–1800 ml). Sixteen patients were transfused in all requiring 32 units of blood, with an average of 2 units per patient. The average duration of hospital stay was 10.1 days (5–45 days). The mean blood loss through drains was 396 ml (10–2000 ml)

BACKGROUND. From 1995 the cost of litigation to the National Health Service (NHS) from surgical procedures has been over 1.3 billion GBP. Spinal patients can present diagnostic challenges and the consequences of delayed diagnosis and surgical complications can be devastating. As a consequence these patients represent a high risk when surgeons seek to indemnify themselves. We therefore, aim to highlight the litigation patterns for these injuries within the United Kingdom. METHOD. Data was obtained from the NHS Litigation Authority from 2002 to 2010 which was analysed. RESULTS. Of the 236 claims, 144 were related to trauma or acute diagnostic issues and 92 from elective surgery. The total financial burden to the NHS came to 60.5 million GBP/72.5 million Euros. Of this sum 42.8 million GBP/51.3 million Euros were paid in damages, and the remaining 29% in legal costs. The financial costs were on average similar for trauma and elective cases. The most frequent cause of successful litigation for trauma were, missed fractures (41.7%), missed cauda equina (23.6%) and spinal infection (11.8%). The emergency department (43.8%), orthopaedic surgery (28.5%) and Medicine (13.9) bore the brunt of the claims. For elective surgery, Spinal Damage(19.8%), failure in Post-Operative Care (15.4%), Infection (11%) and Wrong Level Surgery, Cauda Equina and Surgical Failure at 9.9%. were likely to result in a successful claim, and the litigation burden was felt by the orthopaedic(60.4%), Neurosurgery(18.7%) and other surgical disciplines (11%). CONCLUSION. Acute spinal fractures, cord compression and infection should be considered in patients in the emergency department setting, with appropriate examination and investigations for uncertainty. A lack of awareness of at risk cases increases the likelihood of a pay-out and sums involved. For elective spinal surgery, a failure in the consenting process and the technical skill of the surgeon are likely to result in a pay-out. A failure to identify post-operative complications such as infection and thromboembolism are also indefensible. Protecting patients intra-operatively and maintaining high technical expertise and vigilance post-operative in an adequately consented patient may decrease litigation rates

NHS Patients can wait up to 15 months for non-urgent spine surgery. The intended procedure is determined by the outpatient MRI scan. Do changes occur within the spine during the wait for surgery? Would the changes affect the operative decision?. In a prospective study, 105 patients listed for elective lumbar spine surgery at a district general hospital If the MRI scan is over 6 months old, a second scan is performed prior to surgery. Changes that alter the operative decision are noted. 44% Discectomy, 17% decompression, and 19% fusion plus decompression patients cancelled surgery due to improvement in symptoms. None of the spinal fusion patients cancelled. 14% discectomy; 12.5% decompression; 25% fusion; 19% fusion plus decompression and 65% fusion plus discectomy patients had different procedures after the second MRI. Changes seen include disc resolution, prolapse at a new level, progressive modic changes and compression at other levels. We do not support the fact that patients may have to wait upto 18 months before having elective spinal surgery. However, we found that significant numbers of discectomy and decompression patients found that their symptoms improved enough to decline surgery. No patient that had been listed for fusion alone got better. Due to changes seen on the second MRI scan, 1 in 6 operations were different to the initial planned procedure. Could a surgeon failing to request a further up to date scan prior to surgery therefore be considered negligent?

Objective: NHS Patients can wait up to 18 months for non-urgent spine surgery. The intended procedure is determined by the outpatient MRI scan. Do changes occur within the spine during the wait for surgery? Would the changes affect the operative decision?. Design: A Prospective study. Subjects: 105 patients listed for elective lumbar spine surgery at a district general hospital. Outcome Measures: If the MRI scan is over six months old, a second scan is performed prior to surgery. Changes that alter the operative decision are noted. Results: Forty-four percent discectomy, 17% decompression, and 19% fusion plus decompression patients cancelled surgery due to improvement in symptoms. None of the spinal fusion patients cancelled. Fourteen percent discectomy; 12.5% decompression; 25% fusion; 19% fusion plus decompression and 65% fusion plus discectomy patients had different procedures after the second MRI. Changes seen include disc resolution, pro-lapse at a new level, progressive modic changes and compression at different levels. Conclusions: We do not support the fact that patients may have to wait up to 18 months before having elective spinal surgery. However, a significant numbers of discectomy and decompression patients found that their symptoms improved enough to decline surgery. No patient who had been listed for fusion alone got better. Due to changes seen on the second MRI scan, one in six operations were different to the initial planned procedure. Could a surgeon failing to request a further up to date scan prior to surgery therefore be considered negligent?

Purpose: Harvesting of iliac crest graft for spinal fusions is associated with a number of patients reporting residual pain at the harvest site. Various interventions have been proposed to minimize the pain associated with this. The purpose of this study was to evaluate the efficacy of intra-operative infiltration of morphine into the iliac crest harvest site for reduction of postoperative pain. Method: A double-blinded, placebo controlled study was performed comparing intraoperative infiltration of 5mg of morphine (treatment) vs. saline (placebo) into the iliac crest harvest site for patients undergoing elective spinal surgery. Patients with myelopathy, excessive preoperative opiod use (60mg equivalent morphine/day or more), or multilevel (greater than 3 levels) spinal surgery were excluded. Postoperative administration of morphine (recovery room and PCA) was standardized. Numerical pain scores specific for the iliac crest site were determined in the immediate postoperative period and at 3, 6 and 12 months. Ad hoc power analysis demonstrated that 36 patients would be able to detect a clinically significant difference of 2.4 points on a 10 point numerical pain scale (alpha = 0.05, power = 80%). Results: 37 patients were randomized and evaluated with a minimum of one year follow-up. The groups were similar in baseline age, gender and comorbidity. There was no significant difference between groups in total use of postoperative morphine during the first 24 hours (treatment: 320mg +/− 268mg, placebo: 293mg +/− 182mg, p = 0.73). There was no significant difference in iliac crest activity pain scores at 1 year (treatment: 1.7 +/− 3.0, placebo: 1.1 +/− 2.4, p = 0.48) or at any of the earlier time points. The proportion of patients with moderate to severe iliac crest pain at one year follow-up was the same between both groups. Conclusion: This study has demonstrated that there are no additional benefits for the use of intra-operative infiltration of morphine into the iliac crest harvest site during spinal fusions

Statistics of the clinical activities of an academic training unit was compiled from 1 January 2005 until 31 December 2005. The statistical study had three purposes. Firstly to determine the pathological profile of the patient population and to determine the distribution of patients who needed acute management versus elective surgery. Secondly to determine the needed staff establishment especially with the future anticipated expanding role of the public health sector in the management of orthopaedic patients. The last aim was to create a model of the clinical activities of a junior orthopaedic surgeon during one year of orthopaedic trauma training. Detailed statistics were compiled of all the clinical activities at the two hospitals. The one is a tertiary trauma centre, but also functions at a secondary trauma care level. The second hospital is a referral tertiary care orthopaedic hospital where elective surgery takes place. Furthermore the statistics were also compiled in such a way that detailed doctor activities could be processed from it. There were 181 spinal admissions of which 77 were treated surgically. 106 were treated conservatively. Elective spinal surgery consisted of 20 cases who needed reconstructive surgery and we managed 56 spinal infections. 1263 cases were admitted for orthopaedic trauma management of which 259 had surgery for femur fractures. A total of 250 tibia fractures were treated surgically and a total of 216 radius and ulna fractures. 117 arthroscopic knee procedures were done. A total of 168 arthroplasty cases were treated of which 47 were problem cases. Pathological profile was determined and gave guidance to clinical studies that should be undertaken. The numbers of some types of injuries that were managed are large. Staff establishment assessment can be done and the expansion of it can be motivated for. A model can be compiled for clinical activities of orthopaedic surgeons in training. Extracted from this statistical analysis an activity list was compiled for an orthopaedic surgeon in training. Amongst other minor cases and excluding Paediatric orthopaedic cases – Femur neck fractures 18, Femur fractures 29, Ankle fractures 53, Humerus fractures 12 and adult Supracondylar humerus fractures 9 and Radius Ulna fractures 34 were done

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 spinal surgery. PATIENTS & METHODS: The study was a prospective cohort study. Health status and psychological distress were measured pre-operatively and at 12 months or more post-operatively using the Short Form 36 (SF36) Health Survey Questionnaire and the Hospital Anxiety and Depression Scale (HADS). We compared levels of physical disability (SF-36 physical domain scores) and psychological distress (HADS scores) before and after surgery in this group. Comparisons of pre- and post-operative scores were made using the Kruskal-Wallis, Wilcoxon Signed Rank Test and Mann Whitney U tests as appropriate. RESULTS: A total of 333 patients were included (178 men, 155 women, mean age 54y). Pre-operatively patients with severe levels of anxiety and depression (higher HADS score) had worse (lower) SF-36 physical domain (SF-36 PD) scores compared to those with normal HADS scores (median 181.5 vs 109, p< 0.0001). Both HADS and SF-36 PD scores improved post-operatively (HADS 13 vs 6 p< 0.0001; SF-36 PD 134 vs 250.5 p< 0.0001). Greater reduction in HADS score was observed in patients with severe pre-operative HADS scores compared to those with normal pre-operative HADS scores (p< 0.0001). Patients with severe HADS scores also had greater improvement in SF36 PD scores when compared to patients with normal pre-operative HADS scores (77.24 vs 53.87 p=0.03). CONCLUSION: Poor physical function pre-operatively correlates with severe psychological distress. Both physical and psychological symptoms improve after surgery. Severe levels of anxiety and depression pre-operatively are associated with the greatest symptomatic improvement and psychological morbidity does not worsen outcome

Introduction A prospective cohort study was conducted to assess the incidence of venous thromboembolism (VTE) in 300 patients undergoing elective spinal surgery. Although this subject has been extensively studied in patients undergoing joint replacement surgery, the true incidence of VTE related to spinal surgery remains unknown. We also sought to assess the efficacy of various forms of VTE prophylaxis, another area which has not been adequately studied. Methods Bilateral lower extremity venous duplex scans were performed pre-operatively, within one week postoperatively and at 4 to 6 weeks post-operatively. Information was collected regarding age, gender, body mass index, type and duration of surgical procedure, intra-operative blood loss and blood transfusion, pre- and post-operative mobility and other risk factors for VTE. All patients received vigorous mechanical prophylaxis with 56% of patients receiving pharmacological prophylaxis (unfractionated or low molecular weight heparin) according to surgeon preference. Results The overall incidence of post-operative deep vein thrombosis (DVT) was 3.4%. The incidence in those receiving pharmacological prophylaxis was 1.2% versus 6.3% in those who received mechanical prophylaxis alone (p< 0.05). Just under half of the post-operative DVTs (1.4%) occurred after hospital discharge with none of these patients receiving heparin. There were two cases of pulmonary embolism (0.7%), both occurring during hospitalization, and there were no deaths. There was no difference in blood loss or transfusion rates between patients receiving or not receiving pharmacological prophylaxis and there were no serious complications related to blood loss. There was a surprisingly high incidence of abnormalities detected on pre-operative scanning, with DVT occurring in 3.0% and superficial thrombophlebitis in 24.8%. Discussion The incidence of DVT in patients after spinal surgery was 3.4% and was significantly lower (1.2 %) in patients who received pharmacological prophylaxis. Given that the rates of bleeding-related complications were not different between the two groups, we conclude that it is both efficacious and safe to use pharmacological prophylaxis in combination with mechanical prophylaxis routinely in patients undergoing spinal surgery. A 27.8% incidence of pre-operative venous abnormalities may reflect pre-operative immobility due to pain in this group of patients, and justifies the use of ultrasound scanning as an important pre-operative screening tool. In addition, the high incidence of late-onset DVT justifies the need for follow-up scanning several weeks after discharge. This study is the amongst the largest of its type to date, however a larger, randomized and controlled trial is now necessary to confirm these results and allow the formulation of unambiguous guidelines for spinal surgery and VTE prophylaxis

Aims

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.