There are currently no agreed guidelines for the type and frequency of post spinal surgery neurological observations. This lack of an agreed standard can lead to the failure to adequately monitor cord function following surgery and thus neurological deficits can be missed. We have carried out an audit of the postoperative spinal observations against our agreed standards of care.
All patients should have the frequency of required neuro obs documented in the post op instructions. The frequency of documented observations in recovery should be adhered to. The frequency of documented observations in HDU should be adhered to. Any neurological loss should be properly documented. The nurses will report any neurological change promptly The SHO will exam and document a full neurological examination. 28 case notes were reviewed. 21 of these cases were scoliosis correction through anterior, posterior and combined approaches. 3 had disc replacements, 2 had decompression for metastatic cancer and one had fixa-tion of a fracture. All patients failed to complete all standards fully. There was a lack of clear postoperative guidelines, failure to record neurological status in recovery, incomplete documentation of neurological state in HDU, failure to inform medical staff in presence of a neurological deficit and inadequate assessment of patient by medical staff. One patient returned to theatre for a foot drop, which is still only partially recovered. We recommend the audit of current practice and implementation of locally agreed standards for the postoperative monitoring.
The requirements for a motion segment fusion for degenerative disc disease are relief from symptoms from a solid union with minimal damage to surrounding tissue. This is possible with the ‘Mini PLIF’ using the B Twin cages and facet screws. This procedure produces reliable relief of symptoms with a solid fusion. The use of facet screws mean that the nerve supply of the paraspinal muscles is protected. Between June 2002 and February 2006 35 patients underwent this procedure. There were 13 males and 22 females with an average age of 40 years from all walks of life. 30 patients had back and leg pain with only 5 having solely back pain. 28 patients had surgery at L5/ S1 with 4 patients at L4/5 and 3 at both. The median pre operation ODI was 53 (IQR 60–44) and at one year follow up the ODI was 24 (IQR 37–13). There were two complications of superficial infection and two pseudarthroses requiring pedicle screw constructs and revision bone grafting to achieve union. We believe this procedure demonstrates good relief from symptoms with a good fusion rate preserving the paraspinal muscles.
