Cauda Equina Syndrome (CES) needs to be diagnosed and managed promptly to ensure the best outcome for patients. Our current spinal service has been centralised, with referrals currently delivered via an online system. This means that patients aren't seen by spinal specialists until confirmed radiological diagnosis. To ensure patient safety, we must make sure that our CES pathway is as robust as possible. A Google Forms questionnaire was emailed to various health professionals involved in the CES patient journey throughout the Lancashire & South Cumbria region. Participants were asked to identify problems with our current pathway and to provide possible solutions for improvement. 64 responses were received from 5 different departments throughout 6 NHS employers: 21 (33%) consultants, 6 (9%) middle grade doctors, 31 physiotherapists (48%), 3 (5%) GPs and 3 (5%) others. Many common themes were identified: the need to improve CES education to both referrers and patients (22% responses), addressing the issue of scan availability (39% responses), the need for a clearer pathway for GPs (26% responses) among others. Participants were asked to rate their confidence in the management of both suspected (mean=7.6 +/−2.3) and diagnosed CES (mean=8.0 +/− 2.0).Background
Methods & Results
Spinal surgery is a high-risk surgical speciality, a patient's understanding of surgical interventions, alternative treatment options, and the benefits and risks must be ascertained to gain informed consent. This pilot study aims to evaluate if the provision of a digital recording of a patient's consultation enhances patient satisfaction, improves recall of clinical diagnosis, recall of treatment options and the risks and benefits of Spinal Surgery. A coalition team was identified. A safe and secure process for recording and storage identified. Both qualitative and quantitative data was collected via questionnaires. 62 patients were invited to participate in the pilot, 12 declined. Data was collected immediately post consultation, and two weeks following the consultation via telephone. Comparison was made of the relative increase or decrease in patient recall of the clinical diagnosis, treatment options, and the benefits and the risks of spinal surgery. Patient satisfaction was measured pre- and post- consultation. 50 patients (81%) participated. 32 participants (52%) responded to follow up questionnaire at 2 weeks. Recall of risk for surgical intervention increased by 37%, and of benefit by 36%. Patient satisfaction was rated excellent or very satisfied in 93% at initial consultation and at 2 week follow up all participant's rated satisfaction as excellent or very satisfied.Purpose of study and background
Methodology and results
Degenerative cervical myelopathy resulting in cord compromise is a progressive condition that results in significant quality of life limitations. Surgical treatment options available are anterior and/or posterior decompression of the affected levels. Patients are counselled pre-operatively that the aim of surgical intervention is to help prevent deterioration of neurology. Anecdotal evidence suggested improvements in both EMS and PROMs in this cohort of patients. A 2-year prospective study tested this hypothesis. 67 patients undergoing anterior cervical surgery were followed up to two years. Myelopathic features, radiological cord compression, myelomalacia change and levels of surgery were recorded. Pre/post intervention myelopathy scores/grades, and PROM's were recorded. Paired t-test was performed when comparing pre/post intervention scores and Annova test when comparing results across levels. Our prospective study identified statistically significant improvements in European myelopathy scores and grade and patient reported clinical outcomes in the said population.Purpose of Study and Background
Methodology and Results
The authors recognised that patients presenting to the Orthopaedic Spinal Rapid Access Service with symptoms and or signs of cauda equina syndrome may not have the diagnosis confirmed radiologically. Altered sensation in the ‘saddle area’, bilateral sciatica, urinary incontinence or retention, altered bowel habit, and sexual dysfunction are well recognised symptoms of cauda equina syndrome. Recognised side-effects of neuropathic medications commonly prescribed for radicular pain include: altered sensation, urinary incontinence or retention, and sexual dysfunction. We have undertaken a retrospective cohort analysis in order to identify the relationship between prescribed medications and presenting symptoms and signs. 151 patients were referred to the service within a 6 month period. Case notes of 34 patients presenting with symptoms and or objective signs of CES in absence of positive radiological findings were reviewed. Data collected included the patient's age, sex, prescribed medications and presenting symptoms.Introduction
Method
Spinal conditions commonly cause pain and disability. Various non-operative treatments including acupuncture are practiced for these conditions. To evaluate the effectiveness of acupuncture in management of common spinal conditions.Introduction
Aim
