Purpose. To determine whether MRI done prior to reduction altered the surgeon's choice of reduction method. Method. One hundred and four patients were included in this retrospective review. The first component of this study identified the presence of uncontained, herniated discs in this patient group. The MRI scans were reviewed by two teams including a radiology team and orthopaedic team. These scans were assessed without clinical information and the teams did not have access to the patient notes. An Interrater agreement assessment was applied to the data and the most reliable inter-observer variables of disc injury were chosen to identify the presence of a herniated uncontained intervertebral disc. The second part of this study entailed a detailed clinical note review specifically looking at type of reduction, whether it was intended and the reason why a certain type of reduction was chosen. These naturally divided the 104 patients into 5 cohorts including; closed reduction, Intended open reduction due to the documented presence of a ‘dangerous disc’, open reduction following failed closed reduction, open reduction with no documented reason and open reduction due to delay in presentation. Since closed reduction would not be considered in delayed presentations this cohort was removed from data analysis. Additionally the pre and post reduction neurological status was noted. Results. The cohort that included ‘Intended open reduction due to presence of an uncontained disc’ included 11.5% of patients in this data subset. These cases all had MRI's that were documented to have influenced the type of reduction (p=0.006). However 57% of patients with uncontained discs had had attempted closed reduction; 31% were successful and 27% failed. Using the binomial exact test we calculate the 95% confidence interval showing .054 and .208; thus the reduction method was significantly changed by performing MRI. One patient developed neurological compromise after failed closed reduction. This formed 3.6% of 28 uncontained discs that had attempted closed reduction. Conclusion. The risk of neurological deterioration with closed reduction in the presence of an uncontained disc the risk is 3.6% with an overall risk of 2.2% for this cohort. This study confirms pre-reduction MRI to significantly affect surgeon's decision making. Therr is a significant cost to MRI investigation and the incidence of neurological deterioration of 2.2% needs to be seen against this. ONE DISCLOSURE

Cervical bifacet dislocations are devastating injuries and require early reduction and surgical stabilization. Closed reduction is safe and neurological deterioration is rare. Pre-reduction MRI can cause clinical uncertainty as to the safety of closed reduction when a significant sequestrated disc is found. This study explores the direct cord pressures in a bifacet dislocation model with the use of fresh frozen cadaver cervical spines and a Tekscan Pressure Measurement System. Method. Surgical dislocations were created and pressure monitors inserted into the canal. Pressures on the cord from the posterior-superior edge of the caudal body as well as that from the cranial body were assessed at the level of the dislocation. The effects of the presence of a disc and its size, reduction angles and level of dislocation before and during closed reduction were evaluated. Results. The average dislocated spinal cord pressures were measured at 3.81 kPa and increased to 20.22 kPa under traction. This decreased to 1.295 kPa after cervical spine reduction. Average cord pressures as well as peak loading pressures were shown to increase with the increasing size of the prolapsed disc and diminished once the spine was reduced. Conclusion. This model provides additional insight into cervical spine dislocation and the contribution of disc prolapse to cord injury. NO DISCLOSURES

Purpose of the study. To review the primary bone tumours of the spine treated at our unit. Description of methods. Retrospective review of folders and x-rays of all the patients with primary bone tumours of the spine treated at our unit between 2005 and 2012. All haematological tumours were excluded. Summary of results. We treated 15 cases during this period. The median age at presentation was 36 years (8–65). There was a significant delay from onset of symptoms to diagnosis in most cases (median 7 months). Histological diagnoses included:. -Benign tumours.  Active. Hemangioma. 3. Osteoid osteoma. 1. Eosinophilic granuloma. 1.  Aggressive. Osteoblastoma. 1. Giant cell tumours. 2. Aneurysmal bone cysts. 4. -Malignant tumours.  Osteosarcomas. 2.  Leiomyosarcoma of bone. 1. A variety of definitive surgical methods were utilised. Seven patients had a debulking or intralesional resection of the tumour. Eight patients had an attempted marginal excision. This was achieved through anterior surgery only in 1 case, posterior only surgery in 6 cases and combination anterior and posterior surgery in 8 cases. The anterior and posterior surgery was performed in a single sitting in 5 cases and in a staged fashion in 3 cases. Adjuvant radiotherapy and chemotherapy were used where indicated. Three cases presented with significant neurological impairment. Of these 2 made a significant recovery. There were no cases of neurological deterioration following surgery. All 3 patients with malignant tumours died in the follow up period. We had 1 case of hardware failure due to chronic sepsis. Conclusion. Primary bone tumours of the spine are associated with a significant delay in diagnosis. Surgical treatment options and adjuvant therapy should be tailor made for each case depending on the diagnosis. Acceptable results with minimal complications can be achieved with this approach

Objective. Posterior vertebral column resection (PVCR) is indicated in the management of severe rigid spine deformities. It is a complex surgical procedure and is only performed in a few spine centres due to the technical expertise required and associated risk. The purpose of this study is to review the indications, surgical challenges and outcomes of patients undergoing PVCR. Methods. 12 patients with severe spinal deformities who underwent PVCR were retrospectively reviewed after a follow-up of 2 years. Surgery was performed with the aid of motor evoked spinal cord monitoring and cellsaver when available. The average surgical duration was 310 minutes (100–490). The average blood loss was 1491 ml (0–3500). The indication for PVCR was gross deformity and myelopathy which was due to congenital spinal deformities and one case of old tuberculosis. Clinical records and the radiographic parameters were reviewed. Results. Kyphosis of an average of 72 degrees was corrected to 28 degrees. The associated scoliosis was corrected from an average of 49.2 to 21.2 degrees. Ten patients improved neurologically to ASIA D and E. One patient deteriorated markedly, required revision with no initial improvement but reached ASIA E at 6 months after surgery. Four patients had associated syringomyelia. All were re-scanned at 1 year. The three with small syrinx's demonstrated no progression on MRI and the large syrinx resolved completely. In addition to the neurological deterioration, complications included 1 right lower lobe pneumonia. Conclusion. PVCR is an effective option to correct complex rigid kyphoscoliosis. In addition it allows excellent circumferential decompression of the cord and neurological recovery. When the congenital scoliosis is associated with syringomyelia with no other cause evident, it may allow resolution of the syrinx. Key words: Posterior vertebral column resection, severe spinal deformities, myelopathy, syringomyelia. NO DISCLOSURES

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.