The ability to calculate quality-adjusted life-years (QALYs) for degenerative cervical myelopathy (DCM) would enhance treatment decision making and facilitate economic analysis. QALYs are calculated using utilities, or health-related quality-of-life (HRQoL) weights. An instrument designed for cervical myelopathy disease would increase the sensitivity and specificity of HRQoL assessments. The objective of this study is to develop a multi-attribute utility function for the modified Japanese Orthopedic Association (mJOA) Score. We recruited a sample of 760 adults from a market research panel. Using an online discrete choice experiment (DCE), participants rated 8 choice sets based on mJOA health states. A multi-attribute utility function was estimated using a mixed multinomial-logit regression model (MIXL). The sample was partitioned into a training set used for model fitting and validation set used for model evaluation. The regression model demonstrated good predictive performance on the validation set with an AUC of 0.81 (95% CI: 0.80-0.82)). The regression model was used to develop a utility scoring rubric for the mJOA. Regression results revealed that participants did not regard all mJOA domains as equally important. The rank order of importance was (in decreasing order): lower extremity motor function, upper extremity motor function, sphincter function, upper extremity sensation. This study provides a simple technique for converting the mJOA score to utilities and quantify the importance of mJOA domains. The ability to evaluate QALYs for DCM will facilitate economic analysis and patient counseling. Clinicians should use these findings in order to offer treatments that maximize function in the attributes viewed most important by patients

We aimed (1) to determine the factors which influence outcome after surgery for CES and (2) to study CES MRI measurements. 56 patients with evidence of a sphincteric disturbance who underwent urgent surgery (1994-2002) were identified and invited to clinic. 31 MRIs were available for analysis and randomised with 19 MRIs of patients undergoing discectomy for persistent radiculopathy. Observers estimated the percentage of spinal canal compromise and indicated whether they thought the scan findings could produce CES and whether the discs looked degenerate. Measurements were repeated after two weeks. (1) 42 patients attended (mean follow up 60 months; range 25–114). Mean age at onset was 41 years (range 24–67). 26 patients were operated on within 48 hours of onset. Acute onset of sphincteric symptoms and the time to operation did not influence the outcomes. Leg weakness at onset persisted in a significant number at follow-up (p<0.005). Bowel disturbance at presentation was associated with sexual problems (<0.005) at follow-up. Urinary disturbance at presentation did not affect the outcomes. The 13 patients who failed their post-operative trial without catheter had worse outcomes. The SF36 scores at follow-up were reduced compared to age-matched norms in the population. The mean ODI was 29, LBOS 42 and VAS 4.5. (2) No significant correlations were found between MRI canal compromise and clinical outcome. There was moderate to substantial agreement for intra- and inter-observer reproducibility. Conclusions. Due to small numbers we cannot make the conclusion that delay to surgery influences outcome. Based on the SF36, LBOS and ODI scores, patients who have had CES do not return to a normal status. Using MRI alone, the correct identification of CES has sensitivity 68%, specificity 80% positive predictive value 84% and negative predictive value 60%. CES occurs in degenerate discs

Background. The relationship between obesity and cauda equina syndrome (CES) has not been previously evaluated or defined. Aim. Purpose of this study was to examine the presentation, timing of surgery, peri-operative complications and outcome of Cauda Equina Syndrome in relation to Body Mass Index. Methods. A single centre retrospective analysis was performed on 40 patients admitted with cauda equina syndrome. Data was collected regarding patient demographics, body mass index (BMI), co-morbidities, onset & mode of presentation and speed of functional recovery following surgery. Results. There were 18 males and 22 females with an overall average age of 38.9 years. The average height was 168.7 cm, and the average weight was 89.3 kg, giving an average BMI of 30.6 Kg/m2. 80% of patients were considered overweight (BMI 25–29.5) or obese (BMI >30). The average duration of back or leg pain prior to presentation was 4.2 years for the obese group and 1.3 years for the non-obese group. Bilateral sciatica, urinary incontinence and dense peri-anal numbness were the predominant presenting features in the obese group. Onset of symptoms was slow and gradually evolving in the obese group compared to the fast onset in the obese group. In the non-obese group, 71% underwent surgery within 24 hrs as opposed to 31% in the obese group. Average follow-up was 6months (6 weeks to 14 months). We observed that higher the BMI more slower the recovery with residual neurology and sphincter dysfunction. Patients in ideal group had prompt early symptomatic recovery with no residual neurology and full bladder recovery. There was correlation between increasing BMI and increased rate of surgical complications. Conclusion. This is the first study exploring the impact of body mass index on CES presentation and outcome. Specific care in establishing an early diagnosis in obese individuals is imperative for timely intervention

The rate of Metastatic Spinal Cord Compression (MSCC) has been increasing over recent years with increased patient survival from improved cancer treatment. MSCC presents an increasing demand for spinal surgical resources. NICE guidance was issued in 2008 to improve diagnosis and management and to prevent unnecessary delays which may result in disability. The recent advances in management of cancers coupled with improved spinal surgical approaches have improved the outcome in MSCC. Early surgery has been shown to improve restoration of function. A recent systematic review found that surgery produced superior results to radiotherapy alone for the management of MSCC. However, the quality of evidence so far is mostly from observational studies. We would like to use Bluespier to create a database of MSCC patients referred to our tertiary centre. Our database would include all adult patients referred to the spinal surgical service with MSCC. Information recorded would be the diagnosis, time of onset and imaging, comorbidities, previous interventions, clinical findings, ASIA score, mobility status, sphincteric status, Karnofsky, Tokuhashi, Tomita and Bauer scores. These scores have been shown by numerous studies to have the best predictive value for outcome following MSCC. The SINS and Boriani MSCC protocols will be collected and externally validated. Time to surgery, operative data and intra operative complications will be recorded. PROMs will include the Oswestry / Neck disability index, VAS and SF36 scores. Post operative complications, morbidity and mortality will be collected and the details of any other therapy received. We would score the patients on admission and at 3 months, 6 months and one year post operatively (if survival allows). This will be done in out patients and via postal and telephone questionnaires. The database will flag the time intervals. This database will enable us to improve the quality of care given to patients with MSCC, provide evidence to highlight the importance of prompt referral and surgical intervention, audit our care against the standards set out by NICE and establish the risks, complications and outcomes of surgical intervention in this high risk group. It will be the first study to externally validate and compare several different scoring systems and protocols (above) in the same cohort. Finally, the data can be used to perform a costing analysis for the treatment of MSCC in the NHS