Many hospitals do not have a structured process
of consent, the attainment of which can often be rather ‘last-minute’
and somewhat chaotic. This is a surprising state of affairs as spinal
surgery is a high-risk surgical specialty with potential for expensive
litigation claims. More recently, the Montgomery ruling by the United
Kingdom Supreme Court has placed the subject of informed consent
into the spotlight. There is a paucity of practical guidance on how a consent process
can be achieved in a busy clinical setting. The British Association
of Spinal Surgeons (BASS) has convened a working party to address
this need. To our knowledge this is the first example of a national
professional body, representing a single surgical specialty, taking such
a fundamental initiative. In a hard-pressed clinical environment, the ability to achieve
admission reliably on the day of surgery, in patients at ease with
their situation and with little likelihood of late cancellation,
will be of great benefit. It will reduce litigation and improve
the patient experience. Cite this article:
Fractures of the anterior intercondylar eminence in children are relatively uncommon. There is considerable debate as to the best treatment of displaced fractures, but most methods described in the literature involve an open procedure combined with some form of fixation. Using human anatomical dissections, we have shown that the transverse meniscal ligament can become incarcerated within the fracture and act as a block to reduction. We describe an arthroscopic technique which requires no fixation device and report the results of its use in eight displaced fractures. This method gives reliable results and offers the advantage of less potential morbidity.
Our aim was to judge the influence of preoperative psychological disturbance on the outcome of lumbar discectomy. We evaluated 66 patients, before and after operation, using a self-administered questionnaire. Disability was assessed using the Oswestry disability index and psychological disturbance the Distress and Risk Assessment Method (DRAM) score. Patients were classified as normal, at risk or distressed, and the outcome of surgery in the three groups was compared at a follow-up of six months. The mean self-reported preoperative disability was significantly higher in those with psychological disturbance. A total of 54 patients (82%) returned completed postoperative questionnaires. Postoperative disability scores at six months were not significantly different in the three risk groups. Psychological disturbance improved after surgery. Our study suggests that the early outcome of lumbar discectomy is not affected by preoperative psychological disturbance. We conclude that a patient with a symptomatic prolapsed intervertebral disc should not be denied surgery on the basis of preoperative psychological assessment.
