Contents
Introduction to BritSpine
Welcome Messages
Organising Committee & Administrative Staff
Useful Information
Local Hotels & Restaurants
Places of Interest
Nottingham Conference Centre Maps18-19
Social Events
International Faculty
National Faculty
Programme
· Training Day Tue 5 April
· Masterclass Tue 5 April
Committee Meetings
Programme
· Outline & Key
· Scientific Wed 6 April
Thu 7 April
· Scientific · Scientific Fri 8 April
· Patients’ Afternoon Fri 8 April
· Improving Spinal Care Project Fri 8 April
Presentations
· Podium BASS
· Podium BSS
· Keynote Lectures
· Spine Care Strategy
· Grand Masters of Spine
· SRS/BSS
BRITSPINE 2016
3
4-6
7-8
10-12
13-15
16-17
20
21-22
23-28
29
30
31
33-34
35-37
38-43
44-46
47
48
49-51
51-53
54-55
56
57
58
Presentations (continued)
· Podium BASS/SBPR
· Debate “MAGEC” - Trick or Treat
· British Spine Registry
· Podium BSS
· Special Posters
· Guidelines in ASD Surgery
· SBPR Travelling Fellowships
· Address (BOA/SBNS Past Presidents)
· Podium Best of Show
· Podium BASS/BSS Infection/Tumour · Podium SBPR
· Keynote Lecture
· Podium BASS/BSS Trauma/Tumour
· Special Posters
· Instructional Session
Posters
· Back Pain (Lumbar Degenerative)
· Cervical Spine
· Non-Operative Treatments
· Spinal Deformity
· Spinal Infection
· Spinal Trauma
· Spinal Tumour
Posters & Exhibition Floor Plan
Exhibitors’ Profiles
Exhibitors’ Names & Stand Numbers
Dates for your Diary
59-63
64
64
65-67
67-72
72-73
73-77
77
78-81
81-83
83-86
86
86-88
88-93
93-94
95-101
101-103
103-106
107-111
111-112
112-117
117-121
123
124-130
131-132
135
2
Introduction to BritSpine
The first combined meeting of the British Spinal Societies took place in Manchester in 1999. This achieved
the objective of bringing together, for the first time, many of those with an interest in research and
management of the spine and its disorders.
Important cross-fertilisation of ideas occurred, together with the opportunity for developing professional
contact and friendship. It was concluded that such meetings should be repeated, in the initial instance, at
three yearly intervals, but after Birmingham in 2002 it became biennial.
BritSpine conferences are held over 3 days and involve the presentation of the latest spinal surgery
techniques, instructional sessions and free papers. The meeting attracts over 500 delegates.
2014
Warwick
2012
Gateshead
2010
Liverpool
2008
Belfast
2006
Cardiff
2004
Nottingham
2002
Birmingham
1999
Manchester
If you would like to receive more information about BASS (www.spinesurgeons.ac.uk),
BSS (www.britscoliosissoc.org.uk) and SBPR (www.sbpr.info) please visit the registration area, the
societies’ websites or the UKSSB website www.ukssb.com
3
BRITSPINE 2016
9th BritSpine
Welcome message from BritSpine 2016 Organising Committee
Dear Colleagues
It gives us great pleasure to welcome you here to the Nottingham Conference Centre for BritSpine 2016.
Whilst most of the delegates are from the United Kingdom, many have travelled from Europe, North America and beyond. We
welcome everyone, but are especially delighted to greet our guests from overseas who we are sure will add a great deal of interest
and diversity to this special occasion.
Following the successful format of BritSpine 2014 in Warwick, BritSpine 2016 includes a whole day cadaveric workshop on Tuesday,
5th April for trainees who are planning careers in spinal surgery. New to 2016, we have introduced a parallel Masterclass programme
for Fellows and Consultants that will consist of in-depth discussion of clinically challenging cases with recognised experts from the
home faculty.
The academic programme has an exciting mix of podium presentations, posters, keynote speeches, symposia and debates. Some
sessions will be of particular interest to members of the three spinal societies. There are also general interest joint sessions covering a
variety of topics from the legal basis for consent in spinal treatment to the future direction of spinal care and healthcare in general in
the UK that should appeal to all who come to the conference.
We warmly welcome representatives of the Scoliosis Research Society who are joining the British Scoliosis Society in a dedicated joint
instructional session on Thursday, 7th April in the morning.
As in Warwick in 2014 there is a patient/carer participation afternoon on Friday, 8th April. In addition and new for 2016, there is also
a parallel session in which the NHS England Low Back and Radicular Pain Pathfinder Project will be launched. We are looking forward
to welcoming colleagues and friends from a wide spectrum of clinical and non-clinical groups to these sessions to complete what we
are sure will be a memorable 4 days in Nottingham.
We hope you will agree that this programme has something of interest for everyone. We are extremely grateful to our national and
international speakers for giving up their time and for sharing their experiences with us all.
Our thanks also go to Rebecca Williams and her team at the Nottingham Conference Centre, our event manager partners Julie Archer,
Helen Wormall and Stefanie Castellanos of Archer Yates Associates, as well as Julia Bloomfield and Lenka Körner Nahodilová of the
UKSSB, who have all stepped up to the challenge of helping us to bring BritSpine 2016 together.
The trade exhibition of BritSpine 2016 is extremely impressive particularly given the current economic climate. Our thanks, as always,
go to our commercial partners for their very great degree of continuing support for our specialty, most of whom are longstanding
friends of the spinal community. Please take time to visit their stands and talk to their representatives in order to learn about their
latest developments. We are very pleased once again to offer “Speed Dating” at the Welcome Reception on Wednesday evening following the success of
similar events at BritSpine 2014, BSS 2014, BASS 2015 and BSS 2015. We trust this will provide an excellent networking opportunity,
whilst being educational and good fun.
On Thursday evening, the Conference Dinner is being held at Colwick Hall, a magnificent Palladian style Georgian country house
mansion nestling in over 60 acres of parkland. An historic building dating back to Saxon times and once the ancestral home of Lord
Byron. An Eastern Fusion 3-course dinner will be followed by fireworks over the lake and then dancing to the Nottingham-based
band The Spinal Chords.
Thank you for attending BritSpine 2016. We are confident that you will have an enjoyable time both academically and socially. We
are certainly looking forward to catching up with old friends, making new ones and learning much from you, the delegates and the
Faculty.
Nick Birch
BritSpine Co-organiser
BRITSPINE 2016
Nasir Quraishi
BritSpine Co-organiser
Alistair Stirling
BritSpine Co-organiser
4
Welcome message from Alistair Stirling
Chair – United Kingdom Spine Societies Board (UKSSB)
Dear Colleagues
Welcome to BritSpine 2016. The theme for the meeting is “Together”.
This is the 9th BritSpine meeting and is organised by the UKSSB, which is formed of the 3 main UK
Spine Societies – the British Association of Spine Surgeons, the British Scoliosis Society and the
Society for Back Pain Research, with representation from the British Orthopaedic Association and
the Society of British Neurological Surgeons.
Every 2 years the meeting has grown in size and scope. Nick Birch, Nasir Quraishi, myself and the rest
of the Programme Committee have, we hope, provided a thoughtful and wide-ranging programme
in a perfect venue.
The programme for the first time includes a major focus on service development and delivery in the Improving Spinal Care
Project, supported by NHS England philosophically, and in these austere times, financially as well. It is sincerely hoped that
everyone attending will use this opportunity to understand what is being attempted, to engage in constructive criticism,
refining the detail and taking this back to implement in their locality. Through this and professionals working “Together”
patients will see real improvement in their spinal care.
We very much hope that you enjoy the meeting and take away new knowledge and expertise. Please tell us how it can be
done even better next time. Please feel free to speak with me. We value your feedback.
Welcome message from Am Rai
President – British Association of Spine Surgeons (BASS)
Dear Colleagues
I would like to welcome you all to our 9th BritSpine meeting and congratulate Nottingham and the BritSpine organising
committee for hosting and arranging an excellent academic and social programme. It gets better every year!!
The BASS Executive has had a busy year and have produced:
1. Procedure specific patient consents and highlighted with peer review evidence, the consent process (available for all to
download from our website and view the interactive video demonstration).
2. Guidelines on DVT prophylaxis with a lively debate at the AGM to confirm our recommendations.
3. Cauda equina guidelines with support from SBNS, emphasising the need for MRI scanning at the referring hospital.
4. An update regarding private practice which has been very time-consuming and frustrating in that we were not able to
discuss fees (essential for private practice and mandated by the majority of BASS members). I would hope you will all
contribute to our debate at the UKSSB General Meeting and guide us in the right direction. Many members in private
practice have been dismissive of our work and I would encourage them to take part in our debate.
We also recognise that there is change from volume of work to quality. In order to assess quality we need to enforce and
encourage collection of outcome measures. The British Spine Registry (BSR) is the vehicle of choice and currently we have
over 42,000 patients registered (this represents 80% of all patients in specialty registries). I suspect that collection of data
will become mandatory which, in turn, will improve quality delivered to our patients. I feel it is important that we retain its
control as this will further develop spine as a separate specialty.
I would encourage you all to attend the BASS AGM and to participate not only in our debate, but also help elect our new
Executive committee.
5
BRITSPINE 2016
Welcome message from Robert Crawford
President – British Scoliosis Society (BSS)
Dear Colleagues
Welcome to BritSpine 2016 from the British Scoliosis Society. We are grateful to our
Nottingham hosts and to the UKSSB for organising this event and for the opportunity to
hold a combined spinal deformity session with representatives and guest speakers from the Scoliosis Research Society
whose presentations we look forward to hearing.
We thank all those who submitted scientific papers to the meeting and congratulate authors whose work has been selected
for oral or poster presentation.
We are proud to represent spinal deformity surgeons and allied health professionals from Britain and Ireland at this
combined meeting of the 3 societies. As spinal surgery becomes increasingly sub-specialised, we value the opportunity to
spend time devoted to spinal deformity alone, as well participating in the sessions of common interest. Delegates should
find that there is more than enough variety of academic stimulation for everyone throughout the meeting.
Welcome message from Lisa Roberts
President – Society for Back Pain Research (SBPR)
Dear Colleagues
I would like to extend a warm welcome from the Society for Back Pain Research. There has
never been a more important time to research and evaluate interventions in spinal services and the BritSpine team has
organised a wide-ranging programme that is both clinically relevant and timely.
We congratulate all the presenters who have had abstracts accepted for this meeting and look forward to hearing about
your work.
I hope you enjoy the conference and go back to the clinical coal-face re-energised and ready to challenge and change your
practice based on what you hear at BritSpine 2016.
BRITSPINE 2016
6
Organising Committee
Nick Birch
Co-Chair
Consultant Spinal Surgeon
Woodland Hospital
Kettering
7
Nasir Quraishi
Co-Chair
Consultant Spinal Surgeon
Queen’s Medical Centre
Nottingham
Alistair Stirling
Co-Chair
Consultant Spinal Surgeon
Royal Orthopaedic Hospital
Birmingham
Am Rai
President
British Association of
Spine Surgeons (BASS)
Stuart Blagg
Secretary
British Association of
Spine Surgeons (BASS)
Robert Crawford
President
British Scoliosis Society
(BSS)
Elnasri Ahmed
Secretary
British Scoliosis Society
(BSS)
Lisa Roberts
President
Society for Back Pain
Research (SBPR)
Steve Vogel
Secretary
Society for Back Pain
Research (SBPR)
BRITSPINE 2016
Administrative Staff
Julie Archer
Event Management
Archer Yates Associates Ltd
Oxford
Helen Wormall
Event Management
Archer Yates Associates Ltd
Oxford
Stefanie Castellanos
Event Management
Archer Yates Associates Ltd
Oxford
Julia Bloomfield
Lenka Körner Nahodilová
Executive Assistant
United Kingdom Spine Societies
Board RCS London
Policy Officer
United Kingdom Spine Societies
Board RCS London
The BritSpine team is dedicated to ensuring the conference and exhibition run smoothly and that your
attendance at the event is both educational and enjoyable.
If you have any problems or require any assistance, we would be delighted to help you. Please visit us
at the registration area.
The organisers cannot accept responsibility for any information in this guide that may be incorrect or
accept any responsibility for programme changes.
Please note that the distribution of promotional material except by exhibitors on their stands is strictly
prohibited.
BRITSPINE 2016
8
par t•ner•ship
pärtnәr, SHip
noun
NO ONE CAN SOLVE THE WORLDS
HEALTHCARE CHALLENGES ALONE.
LET’S TAKE HEALTHCARE
FURTHER, TOGETHER.
Learn more at medtronic.com/furthertogether.
UC201606350EE ©2016 Medtronic. All Rights Reserved.
9
BRITSPINE 2016
Useful Information For Delegates
Abstracts & Posters
Cancellations
Abstracts will be published in a special supplement of The
Spine Journal which is in your delegate bag. All oral, special
posters and poster presentations are also included within this
programme.
Delegates who cancel their booking will not be entitled to a
refund of fees already paid.
Posters will be on display within the exhibition throughout the
conference and taken down at 12.30 on Friday, 8 April. There
will be poster runs every lunchtime to enable presenters to
discuss contents with delegates.
Prizes will be awarded as follows:

Seven of the highest ranked papers will be presented at the
“Best of Show” papers and be eligible for the best paper
prize.

Additional prizes will be awarded for the best special poster
and poster.
Attendance Certificates – CPD/CME
This conference has been accredited by the Royal College of
Surgeons of England (6 credits for Masterclass (5th April); 6
credits for each of (6th, 7th, 8th April).
An Attendance/CPD/CME certificate will not be provided at
the conclusion of this event. The only method of obtaining
a certificate is online via Survey Monkey as outlined in the
handout in your delegate bag.
Please note that security protection on NHS computers may
prevent access to the Survey Monkey link. It is, therefore,
advisable to complete the survey on a personal computer.
The electronic certificate can be included in CPD/CME portfolios
as proof of attendance at the meeting and, according to current
guidance, should be accompanied by notes on how the meeting
was of benefit to career development or current practice.
Car Parking and Getting Around
Located in the heart of Nottingham, Nottingham Conference
Centre is easy to get to by car and is well serviced by multiple
car parking options adjacent and next door to the Conference
Centre. As part of our events services we offer a range of
discounted City Centre parking options at Q-Park Talbot Street
car park: Q-Park Talbot Street, Stanley Place, Nottingham NG1
5GG. There are two entrances to the car park on Chaucer Street
and Talbot Street.
Day parking (8 hours) - reduced rate: £7.50 per vehicle
Single day - 8 hour secure parking is available at the Talbot
Street multi-storey secure car park for all guests and delegates
at Nottingham Conference Centre. Situated around the corner
from the Conference Centre, this is the best option for anyone
attending a single day event. Simply park in the car park as
normal and bring your token to our reception team.
24 hour parking - £9.50 per vehicle
Overnight parking is also available for guests and delegates
at the Talbot Street car park which can be accessed between
06.00–01.00 (GMT). For larger conferences and events our Event
Team is happy to enquiry about further discounted rates on
your behalf.
Alternative options
To make the day as accessible as possible, we recommend using
one of Nottingham’s Park and Ride services into the centre.
There are also a number of other car parks available in the city
centre.
Audiovisual/Speakers’ Room
Cash Machines
The Audio-visual Speakers’ Room is situated in the Green Room
on Level 1. Presenters should register their attendance prior
to the start of the session in which they are speaking. The
opening times are:
Cash machines are located 2 minutes’ walk into the city centre.

07.30 on Wednesday 6 April

07.30 on Thursday 7 April

07.30 on Friday 8 April
Badges and Security
For security purposes all delegates, accompanying persons and
exhibitors MUST ensure they are wearing the official BritSpine
name badge AT ALL TIMES whilst in the Nottingham Conference
Centre. There will be specific colour-coding to distinguish
faculty, delegates and conference organisers.
Business Centre
There is a print shop available on Level 1 which is are open
09.00-16.00
BRITSPINE 2016
Catering
Tea, coffee and biscuits will be served amongst the exhibition
during the conference breaks each morning and afternoon on
Level 0 and Level 2.
Lunch bags will be provided in the exhibition to delegates,
faculty, organisers and trade delegates who have appropriate
badges. Lunch bags can be collected from the exhibition and
taken to Level 2 if attending a workshop.
Please note that only one lunch per delegate is available. Special
dietary requests are available only to delegates who requested
these in advance. For those who would like something different,
there are restaurants and cafes nearby.
Cloakroom
The cloakroom is on Level 1 in Lecture Theatre 3 and is manned
throughout the conference.
10
Useful Information For Delegates
Conference Event App
Message Board
To download the event app please follow the steps below:
A message board is located in the registration area. This is
for use by delegates to make contact with other delegates. It
should not be used for promotional purposes such as displaying
literature about other events.
1.: Download the app enter https://crowd.cc/s/c6Sg into your
mobile browser. If you are using a Blackberry or Windows
device, access the app by entering https://crowd.cc/
BRITSPINE2016 in your devices mobile browser.
2.: Download the Event open the app and tap on
BRITSPINE2016 Event Code BRITSPINE2016.
icon in the upper left corner and tap
3.: Login Tap the
Log In for more features. You will be prompted to enter
your registration code which is included in your invitation
email. Enter it in the appropriate field, then enter either the
email address where you received the invitation or your
first and last names.
Exhibition
Delegates are encouraged to visit the exhibition which is located
on Level 0 and Level 1. The exhibition is open throughout the
conference, but will close at 14.00 on Friday 8 April. Information
on exhibitors and their products can be found at the back of
this guide.
Fire Regulations
If the fire alarm sounds it is important to leave the building
calmly and quickly to the nearest fire exit and to the assembly
point. Fire marshals will also be on hand to assist. All guests
will have access to a map of exits at the registration desk.

Goldsmith Street – Spanky Van Dykes

Shakespeare Street – The Orange Tree
Mobile Telephones/Pagers
Delegates must ensure that mobile telephones and pagers are
switched off or in silent mode during all sessions.
People with Disabilities
Nottingham Conference Centre is proud to have achieved the
CredAble Provider mark. This is even more of an achievement
given that the building is Grade II* listed and subject to limited
modifications. All our rooms and facilities are accessible by
wheelchair via ramps, lifts and power assisted doors. Elements
such as lift buttons are also rendered in braille and mobility
impaired delegates also have their own personal evacuation
plan so they are taken care of in the event of an emergency. We
aim to make our services easily accessible to everyone through
provision of a range of alternative channels. For example, our
printed material can be provided in large print or Braille format
on request.
Nottingham Conference Centre, as part of Nottingham
Trent University, has shown outstanding consideration for
accessibility through its building design, facilities and high
standard service provision by dedicated staff. Clients choose
the centre for their events with full confidence that their
delegates’ needs will be attended to, leading to bookings from
the British Society of Audiology, Hidden Hearing and for the
second year running, the Interactive Technologies and Gaming
Conference, which focuses on using interactive technology
to overcome issues of accessibility and disability. All of these
events invited delegates with additional requirements which
have been attentively managed by the conference team.
First Aid
A designated first aider will be available each day of the
conference. Please ask at the registration desk if assistance is
required.
Photography
Photography or video recording are not permitted during
sessions except by the official conference photographer and
video film maker.
Internet Access
There is Internet access throughout the venue. NTU_Guest
network is available across the entire Nottingham Trent
University (NTU) campus. This network is limited to web only
(ports 80 http and 443 https). Delegates can access this network
by connecting to the NTU_Guest network and accepting the
terms and conditions and providing an email address.
Local Information
The Nottingham Conference Centre has a selection of literature
covering local information, attractions and events. A selection
of local attractions are highlighted within this guide.
11
Prayer Room
A prayer room is available on Level 2. If this is required please
contact the registration desk for access.
Recycling
Recycling bins have been provided throughout the venue to
recycle plastic and paper, including unwanted abstract books
and programmes. Please use these whenever possible and help
reduce the environmental impact of the conference. Unwanted
delegate bags, etc can be recycled via the registration area.
BRITSPINE 2016
Useful Information For Delegates
Registration Area
Venue
The registration area is located on Level 1 by the main
reception desk in the Nottingham Conference Centre and is
open throughout the conference. Delegates are asked to visit
the registration area should any queries arise concerning the
event. The opening times are 07.30-18.00 Wednesday and
Thursday and 07.30-16.00 Friday.
Nottingham Conference Centre
Burton Street
Nottingham
NG1 4BU
Registration Onsite
On-site registration will be through www.britspine.com and can
be accessed through personal laptops/tablets/smartphones
using the NTU_Guest Wi-Fi or through an iPad available in the
registration area. On-site payment can be made by credit card
(Visa/MasterCard) or a debit card. No other forms of payment
will be accepted.
Social Events
Delegates who have booked for the Conference Dinner will
receive their tickets in their delegates’ badge holders. Please
inform conference staff if you are unable to attend. Refunds
will not be available for Conference Dinner cancellations, but in
the event of a shortage of tickets, we will be happy to note any
cancellations in order to inform delegates wishing to attend.
OBTAINING THE OPTIMUM. TOGETHER.
We are looking forward
to welcoming you to
the BritSpine 2016 at
our booth no. 8a!
At Silony Medical we work with passion and commitment, doing everything possible
to achieve the best results. We work in partnership with clinicians, solving problems,
going beyond the accepted standard and looking at new trends that improve patient
outcomes and best practices. Our core values – quality, integrity and teamwork – guide
our work every day and with every patient.
Our Lunchtime Symposium with the title
“Future Trends in Spinal Surgery” is
Wednesday April 6th. Our guest speakers are
Prof Michael Mayer and Mr Bronek Boszczyk.
Further information will be provided at our
booth – please feel free to contact us.
www.silony-medical.com
Anzeige Silony_185x131_110216.indd 1
BRITSPINE 2016
11.02.16 12:37
12
Nearby Hotels
Crowne Plaza Nottingham
Roomzzz Aparthotel
Tel: 0871 9429161
Wollaton Street, Nottingham NG1 5RH
Tel: 0115 7315000
Stanley Place, Nottingham
NG1 5GS
Jury’s Inn Nottingham
Tel: 0115 9016700
Waterfront Plaza/Station Street, Nottingham NG2 3BJ
St James Hotel
Tel: 0115 9411114
1 Rutland Street, Nottingham
NG1 6EB
Park Plaza
Tel: 0844 4156730
41 Maid Marian Way, Nottingham NG1 6GD
Ramada Nottingham City Centre
Tel: 0115 9128000
19-31 Wollaton Street, Nottingham NG1 5FW
13
BRITSPINE 2016
Nearby Restaurants
To receive discount codes and offers please pick up a flyer from the registration desk.
Anoki
The Ned Ludd
Tel: 0115 9483888
Tel: 0115 9484221
Friar Lane, Nottingham NG1 6DA
Serving craft beer, real ale and real ciders with a menu of home
cooked locally sourced artisan food
Receive 10% discount off your food bill
Barker Gate, Nottingham NG1 1JU
Located in the heart of the historic Lace Market you will be
served award winning Indian cuisine
Receive a free starter with main course ordered
Byron’s Brasserie, Colwick
Tel: 0115 9500566
Colwick Hall Hotel, Racecourse Road, Colwick NG2 4BH
Enjoy British food in a classic English setting at the beautiful
Colwick Hall just outside the city
15% off the a la carte menu (excluding the offers menu)
Marco-Pierre White Steakhouse Bar and Grill at Alea
Casino
Other restaurants available
nearby
British
Pitcher and Piano
Tel: 0115 9586081
High Pavement, Nottingham NG1 1HN
Tel: 0115 8720602
Browns Restaurant and Brasserie
Wollaton Street, Nottingham NG1 5FW
Located at Alea’s state of the art casino serving tantalising
steaks and delicious British dishes
Take 10% off your food bill
Tel: 0115 9588183
20 Park Row, Nottingham NG1 6GR
Mem-Saab
Tel: 0115 8475587
Newdigate House, Castle Gate NG1 6AF
Tel: 0115 9570009
12–14 Maid Marian Way, Nottingham NG1 6HS
A fine dining Indian restaurant offering traditional and
contemporary cuisine
10% off food bill from the a la carte menu (excludes Saturday and
drinks)
Red Hot World Buffet Shack
Tel: 0115 9589899
Trinity Square, Nottingham NG1 4DB
Located in the Cornerhouse this is a food lover’s fantasy with
an all you can eat concept
Enjoy 20% off the total bill
The Cross Keys
Tel: 0115 9417898
World Service Restaurant
Loch Fyne Restaurant
Tel: 0115 9886840
17 King Street, Nottingham NG1 2AY
French
Le Mistral Bistro
Tel: 0115 9410401
Eldon Chambers, 2-3 Wheeler Gate, Nottingham NG1 2NS
French Living – Café Restaurant
Tel: 0115 9585885
27 King Street, Nottingham NG1 2AY
15 Byard Lane, Nottingham NG1 2GJ
A real ale pub steeped in hundreds of years of history serving
essentially British based dishes
Take 10% off your food bill
The Larder on Goosegate
Tel: 0115 9500111
16–22 Goosegate, Hockley, Nottingham NG1 1FE
Offering traditional & modern British cuisine located in the
heart of the Lace Market
Receive 15% off the a la carte menu (Tue–Fri)
BRITSPINE 2016
14
Italian
Japanese
Zizzi’s
Wagamama
Tel: 0115 9509654
12 King Street, Nottingham NG1 2AS
Tel: 0115 9241797
The Cornerhouse, Burton Street, Nottingham NG1 4DB
YO! Sushi
Jamie’s Italian
Tel: 0115 8221421
24-26 Low Pavement, Nottingham NG1 7DL
Tel: 0115 8720280
1 Weekday Cross, City Centre, Nottingham NG1 2GB
Latin American
Las Iguanas
Pizza Express
Tel: 0115 9529095
20 King Street, Nottingham NG1 2AS
15
Tel: 0115 9596390
Chapel Quarter, 4 Chapel Bar, Nottingham NG1 6JS
BRITSPINE 2016
Places of Interest
Calm Water Floatation
Framework Knitters Museum Ruddington
Tel: 0115 9825259
1A Mabel Grove, West Bridgford, Nottingham NG2 5GT
Located near to Trent Bridge near the city, this is a dedicated
floatation tank centre and is a unique concept in relaxation.
Take £10 off by quoting EN
Tel: 0115 9846914
Chapel Street, Ruddington NG11 6HE
See how the knitters lived and worked and how it lead to the
Luddite revolt and the birth of the Nottingham Lace Industry.
Receive exclusive 2 for 1 entry
D H Lawrence Heritage
Galleries of Justice Museum
Tel: 01773 717353
Mansfield Road, Eastwood NG16 3DZ
See his literary legacy and the physical locations of D H
Lawrence’s life at the Birthplace Museum and Heritage Centre
Enjoy 2 for 1 entry
Tel: 0115 9520555
High Pavement, Nottingham, NG1 1HN
A unique award winning museum inside Nottingham’s old
courthouse and gaol.
Take 20% off entry prices
Felley Priory
Great Central Railway Ruddington
Tel: 01773 810230
Underwood, Nottinghamshire NG16 5FJ
Dating back to the 12th century the house and its 2.5 acre
tranquil garden are nestled in beautiful countryside
Take 10% in the nursery or tea room
Tel: 0115 9405705
Mere Way, Ruddington, Nottingham NG11 6NX
Travel through almost 10 miles of beautiful scenery aboard
heritage steam and diesel locomotives
Receive 20% discount on full price fares (excludes special
events and gala days)
BRITSPINE 2016
16
Places of Interest
Warwick Castle
Nottingham Castle
Nottingham City Tours
Tel: 0115 9155555
Friar Lane, Nottingham NG1 6EL
Visit the museum and caves at this magnificent ducal mansion
built on the site of the original medieval castle
Children go free with a paying adult
Tel: 07931 431621
Discover places you never knew in Nottingham as
you are led on a 90 minute walking tour of the city
Exclusive price of £5.00 per adult, £3.00 per child
Madame Parboiled
Tours of Nottingham
Tel: 07931 431621
Nottingham Castle, Friar Lane, Nottingham NG1 6EL
The Executioner’s wife presents the gory side of Nottingham’s
history through Nottingham Castle’s notorious dungeons
Receive 50% off adult ticket prices
Tel: 07850 145642
Ye Olde Salutation Inn, Maid Marian Way NG1 6AJ
Discover fascinating facts and marvellous myth in a tour of
Robin Hood’s city including Heroes & Villains Tours
10% or £1 off (whichever is greater) per person quoting
MAP14 (excludes Ghost Walk)
Newstead Abbey
Tel: 01623 455900
Newstead Abbey, Nottingham NG15 8NA
A beautiful historic house set in glorious landscape and once
home to notorious poet Lord Byron
Children go free with full paying adult
17
BRITSPINE 2016
Nottingham Conference Centre Map and Directions
Directions to Nottingham Conference Centre
By rail
By car
Nottingham Midland Station is the mainline train station close to
Nottingham city centre. The train station is a 15 minute walk
from Nottingham Conference Centre, but for those new to the
city it might be easier to take a taxi or use Nottingham’s tram
NET (Nottingham Express Transit) system.
From the north, exit the M1 at junction 26 and follow the signs
for the A610 towards Nottingham city centre.
The tram terminus is adjacent to the train station and all trams
from this terminus travel close to Nottingham Conference
Centre, offering a fast and frequent service. Leave the tram at
the Nottingham Trent University tram stop on Goldsmith Street
and walk past the main University entrance, turn left on to
Burton Street where you will find the Nottingham Conference
Centre entrance.
By air
The closest airport to Nottingham is East Midlands Airport
which is 15 miles (approximately 24 kilometres) outside of the
city. It takes about half an hour from there to travel into the city
by car or bus.
There is a Skylink bus service that runs every half hour from the
airport into Nottingham city centre and stops a few minutes
walk away from Nottingham Conference Centre.
There is a Park and Ride (tram) facility situated close to the M1
junction 26. The Park and Ride (Phoenix Park) site is clearly
sign-posted off the A610.
Leave the tram at the Nottingham Trent University tram stop
which is located on Goldsmith Street and walk past the main
University entrance, turn left on to Burton Street where you will
find the Nottingham Conference Centre entrance.
From the south, exit the M1 at junction 24 and follow the signs
for the A453 to Nottingham city centre.
The Queen’s Drive Park and Ride is located just off the A453
(Queen’s Drive), follow signs for A453 / Queen’s Drive Industrial
Estate and merge on to the A453 (Queen’s Drive). The Park
and Ride is located on the opposite side of the road to the retail
park and is clearly sign-posted.
Alight from the Park and Ride bus on Lower Parliament Street
(Victoria Centre); Nottingham Conference Centre is a short walk
away.
Car parking
Car parks in the city centre are clearly signposted from all major
approach routes.
There are two car parks close to Nottingham Conference
Centre, Trinity Square car park on North Church Street and
Talbot Street car park. For satellite navigation systems please
use the following information:
Trinity Square car park: postcode NG1 4BR
co-ordinates 52.956785,-1.149316
Collegiate Church of St Mary
Talbot Street car park: postcode NG1 5GG
co-ordinates 52.956143,-1.154433
BRITSPINE 2016
18
Nottingham Conference Centre Room Plan
WELCOME TO
NOTTINGHAM CONFERENCE CENTRE
ROOM PLAN
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Call us to discuss your next event
+44 (0)115 848 8000
enquiries@nottinghamconferencecentre.co.uk
www.nottinghamconferencecentre.co.uk
LEVEL 1
THE OLD
LIBRARY
THE OLD
MUSEUM
This room was
once the original
city library. It’s
now our bespoke
dining room.
The Old Museum
housed a natural
history
collection –
including a
stuffed gorilla –
which is now
relocated nearby
in Wollaton Hall.
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THE OLD CHEMISTRY THEATRE
wE
As the name suggests, many audiences
have been wowed by scientific
experiments being performed here, the
most famous of which was the invention
of silicone by Dr Frederick Kipping in the
late 19th Century.
Green
room
Booth
room
Main Entrance
s
Potter
room
s
LEVEL 2
SUGGESTED ROUTE TO THE ARKWRIGHT ROOMS
FROM THE CONFERENCE CENTRE
wE
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qqq
qE
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Benefactors’ Court
s
Bowden room
The Old
Chemistry
Theatre
Adams room
The Old
Museum
Central Gallery
Kilpin room
s
Hooley room
s
qqq
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The Old Library
Central Court
s
s
s
LEVEL 3
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X
wE
Lecture
Theatre 2
s
Newton Forum
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Knight room
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Fothergill room
Sillitoe room
Main Entrance
5661/05/14
19
BRITSPINE 2016
Social Events
Opening Reception and Speed Dating
Wednesday 6 April – 18.45-21.00
Nottingham Conference Centre Level 1 and Level 0
The Opening Reception will take place along with “speed dating”.
Delegates will stand in front of each stand (beer, wine and canapés to be provided). Delegates will then speak to the company
representatives for 5 minutes, after which time a bell will ring and the delegates will then move onto the next stand. There will be
15 formal speed dating slots from 18.45 to 20.15 after which the Welcome Reception will continue in an informal way.
Conference Dinner
Thursday 7 April – 19.00-23.00
Colwick Hall
Transport
 Coaches will collect from the Nottingham Conference
Centre at 19.30 and take delegates to Colwick Hall.
 Return coaches will depart from Colwick Hall from 23.30-
01.00 and return to the Nottingham Conference Centre for
delegates to make their own way back to their hotels.
Join us for our conference dinner at Colwick Hall, a
magnificent Palladian style Georgian country house mansion
nestling in over sixty acres of parkland. An historic building
dating back to Saxon times and once the ancestral home of
Lord Byron.
atmosphere and themed cuisine. There will be entertainment
from the one and only local band “The Spinal Chords” featuring
some faces many of you will recognise!
We also have planned several other activities that will certainly
keep you entertained throughout the course of the evening,
making it a memorable and fun occasion for all.
If you have not yet purchased a ticket and wish to
do so, please visit the registration desk.
Tickets are priced at £65.00 + VAT per person.
The evening will take place in the Lakeside Pavilion overlooking
the country park where there will be a relaxed “Asian Fusion”
BRITSPINE 2016
20
International Faculty
Daniel Chopin - France
Neuro-Orthopedic Spine Unit, Pole
Neuroscience and Locomotion,
Hopital Roger Salengro University
of Lille. Past-Director of the “Centre
d’étude et de traitement des
affections du rachis” at Institut
CALOT September 1977-May
2010 1st President - SFCR (Societe
Française de Chirurgie Rachidienne
- French Society of Spine Surgeons) Member - Scoliosis
Research Society (USA) Past Chairman - International Affairs
Committee. Member - SOFCOT (Société Française de Chirurgie
Orthopédique et Traumatologique). Member - GES – PastPresident (French Group of Scoliosis Research).
Member - Spine Societies of Europe .Honorary Member
- British Scoliosis Society. Honorary Member - Turkish
Orthopedic Society. Honorary Member - Australian Scoliosis
Society. Honorary Member - Quebec Scoliosis Society.
Member – IGASS Board. Guest speaker of many spine
meetings all around the world. Research works on adult spinal
deformities, 3D reconstruction, simulation of spinal correction
(with School of Ingenieurs, University of Valenciennes),
development on pelvic fixation with CDI interpedicular plate,
co-conceptor of Colorado Instrumentation Telamon carbon
cage, experimental and clinical works on ceramics in spine
fusion.
Philadelphia (CHOP) from 1996-2015 and held the Richard M
Armstrong Endowed Chair in Pediatric Orthopaedic Surgery.
He was Professor of Orthopaedic Surgery at the University
of Pennsylvania. Dr Dormans served as combined President
of the Medical Staff of the Children’s Hospital of Philadelphia
and President of Children’s Surgical Associates (CHOP surgical
group) for four 3-year terms. He was the recipient of both the
Jesse T Nicholson Award for Excellence in Clinical Teaching
and the Dean’s Award for Excellence in Clinical Teaching
from Penn in 1995. He was an AAOS and AOA Kashewagi
Suzuki travelling fellow to Japan in 1996. He is the immediate
past President of the Scoliosis Research Society (SRS) and
was President for the SRS 2015 50th anniversary meeting
in Minneapolis, Minnesota. Dr Dormans won the SRS Hibbs
Award for Best Basic Science Paper in 2011 and Best Clinical
Paper in 2006.
Additionally, he is President of the World Orthopaedic
Concern. Dr Dormans is a past Chairman of the Board of
Directors Orthopaedics Overseas and served on the Board of
Directors of the Decade of the Bone and Joint Project. He was
the President of the Pediatric Orthopaedic Society of North
America for 2009-2010 and currently serves as the Treasurer
of SICOT International and Secretary General of the SICOT
Foundation. He has published over 340 articles, authored
more than 145 chapters and written/edited 10 books. He has
participated as an invited lecturer in nearly 60 countries. Dr
Dormans was also the Director of the Pediatric Orthopaedic
Fellowship at CHOP and has trained over 50 clinical fellows
and 100 research fellows.
Benny Dahl - Denmark
Is an orthopaedic surgeon who
has 20 years’ experience in spine
surgery. He is clinical professor in
spine surgery and an active member
of the SRS. He serves as a member
of the SRS program committee and
is the chair-elect for the World Wide
Courses. He holds a PhD in basic
science and a doctoral thesis on
inflammatory response after severe trauma and spine surgery.
He is involved in a number of international research projects
in collaboration with AO Spine and SRS and has received both
the Whitecloud Award and Hibbs Award in clinical research.
John P Dormans - USA
Is the Chief of Texas Children’s
Hospital Department of
Orthopaedic Surgery and Scoliosis,
LE Simmons Chair in Orthopaedic
Surgery and Tenured Professor at
Baylor College of Medicine. He
served as the Chief of Orthopaedic
Surgery at the Children’s Hospital of
21
Ferran Pellisé - Spain
Is currently Chief of the Spine Unit
at Hospital Universiatri Vall Hebron
and Director of the Spine Unit at
Hospital Quiron in Barcelona. He
serves as Associate Professor at the
Department of Orthopaedics and
Traumatology at the Universitat
Autonoma de Barcelona, Spain.
Dr Pellisé is member of different
medical spine societies including the Spanish Spine Society
(2013-2014 President), EUROSPINE (2003-2004 Program
Committee Chair, 2006-2009 Secretary and 2012-2013
President) and Scoliosis Research Society (2015-2017 Global
Outreach Committee Chair). He has been Deputy Editor
for Reviews of the European Spine Journal from 2005-2015.
In 2010 he founded, together with other European spinal
deformity surgeons, the European Spine Study Group to
evaluate clinical outcomes for conservative and surgical
treatment of adult spinal deformity.
BRITSPINE 2016
International Faculty
Shanmuganathan
Rajasekaran – India
Joost van Middendorp –
The Netherlands
Is Chairman of the Department of
Orthopaedics and Spine Surgery
at Ganga Hospital, Coimbatore.
He is currently the President-Elect
of SICOT and Chair of AOSpine
International Research Commission.
He was the Hunterian Professor
of the Royal College of Surgeons
of England (2012) and the Past-President of the Indian
Orthopaedic Association (2012), Association of Spine Surgeons
of India (2009-13) and International Society for the Study
of Lumbar Spine, Canada (2012). He is the Deputy Editor
of the Journals SPINE, Global Spine Journal and Journal of
Craniovertebral Surgery. He is also on the Editorial Board of
the European Spine Journal. His research interest relate to disc
biology and nutrition, imaging of spinal cord injuries and open
injuries for which he has received numerous international
awards, including the prestigious ISSLS Prize for Spine
Research for 2004, 2010 and 2013; EuroSpine Open Paper
Award for 2008 and Macnab LaRocca Research Award,
Canada, 2005.
Qualified in medicine from Utrecht
University in 2007 and 3 years later
he was awarded a PhD degree, cum
laude, for his paradigm-shifting
research into spinal trauma. During
his post-doctoral research fellowship
in Brisbane, Australia he also
completed his training in Clinical
Epidemiology at the University of Queensland. In March 2012
he moved to Oxford and became the Research Director of
Stoke Mandeville Spinal Research, based in the National Spinal
Injuries Centre at Stoke Mandeville Hospital and was also a
senior research fellow of Harris Manchester College, University
of Oxford. Since January 2015 he works for Pfizer in The
Netherlands.
BRITSPINE 2016
22
National Faculty
Sashin Ahuja
Ashley Cole
Is a Consultant Orthopaedic Spinal
Surgeon at Cardiff and Vale University
Health Board since 2003 after training in
India and the UK. He is Research Chair
of the BSS Executive Committee and
on AO Spine UK Council. He is the past
Research Chair of BASS. Throughout his
career he has been actively involved in education (convening
courses annually for senior trainees and consultants), training
(as a lead for fellowship programmes with BOA recognition)
and research (publishing in peer reviewed journals and book
chapters). He has been an expert adviser to NICE and Welsh
Assembly Government for guidelines and policy.
Graduated from Nottingham in 1991
and has been a Consultant Spinal
Surgeon at the Sheffield Children’s and
Northern General Hospitals in Sheffield
since 2003. He wrote a BMedSci thesis
on Gait Analysis in Adolescent Idiopathic
Scoliosis as a medical student and
subsequently a DM thesis on the Results of Surgery in AIS. He
has been on the Executive Committees of AO Spine UK, British
Association of Clinical Anatomists and the British Association
of Spine Surgeons. Between 2010 and launch in 2012, he
co-developed the British Spine Registry with which he is still
closely involved. He is currently on the Executive Committee of
the British Scoliosis Society and UK Spinal Societies Board. He
remains the Spinal Chair of the Orthopaedic Expert Working
Group advising on spinal coding, healthcare resource groups
and tariff. After being a member of the last Spinal Taskforce, he
became Chair of the Complex Spinal Surgery Clinical Reference
Group advising NHS England on commissioning specialised
spinal surgery. He sits on the Trauma Programme of Care Board
and is currently Clinical Lead for the Regional Spinal Networks
project supported by NHS England.
Robin Chakraverty
Is the Chief Medical Officer to British
Athletics where he is responsible for 140
Olympic and Paralympic athletes. He
has worked full-time in sports medicine
since 2008. From 1999-2008 he worked
as a Sports and Spinal Physician in the
Spinal Unit of the Royal Orthopaedic
Hospital NHS Trust, Birmingham where
he became proficient in the conservative management of low
back issues and spinal injection procedures. Having worked as
a Medical Officer in Her Majesty’s Royal Navy (1989-96) where
he trained as a General Practitioner, he subsequently trained as
an osteopath (London College of Osteopathic Medicine).
Daniel Chan
Qualified from University College
Dublin in 1982. He obtained all his
post-graduate orthopaedic training
in the UK with the exception of one
of his Spinal Fellowships which was in
the Duchess of Ken Children’s Hospital
in Hong Kong. He obtained training
through the Royal Orthopaedic Hospital
programme at registrar level and the Robert Jones and
Agnes Hunt Orthopaedic Hospital programme in Oswestry
at Senior Registrar level. He completed two Fellowships
in Spinal Surgery, one in Hong Kong and one at St James’
University Hospital in Leeds. He was appointed as Consultant
to the Princess Elizabeth Orthopaedic Centre at the Royal
Devon and Exeter Hospital in 1996 and had been practicing
full-time spinal surgery since. His spinal practice spans all
pathologies, with the exception of intradural pathology. Work
ranges from microsurgery to the lumbar and cervical spine to
complex reconstruction surgery for tumours, fractures, and
degenerative conditions. He has a special interest in anterior
spinal surgery and also has a spinal deformity correction
practice.
23
Robert Crawford
Is a Consultant Orthopaedic Spine
Surgeon at the Norfolk and Norwich
University Hospital NHS Trust. He is
President of the British Scoliosis Society
and a member of the United Kingdom
Spine Societies Board (UKSSB).
Alan Crockard
Graduated from the Queen’s University
Belfast in 1966 and began neurosurgical
training in 1969 as the “Troubles”
began. There, he was appointed Senior
Lecturer from 1974-1978 before moving
to the National Hospital for Neurology
and Neurosurgery, London where he
remained until 2005. He was a tutor and
then Director of Education at the Royal College of Surgeons,
London from 1997-2003. He was awarded a personal Chair
in the University of Western Australia and subsequently
the Institute of Neurology, London. He has received
numerous prizes and awards, including the Olivecrona Medal
(Stockholm), Hunterian Professorship, Wellcome Senior
Surgical Fellowship and MRC Fogarty Fellowship. He was
President of the British Cervical Spine Society and European
Cervical Spine Research Society. He has authored 350 articles,
90 book chapters and edited 2 books. In retirement, he enjoys
sailing, photography and birdwatching with his wife, Caroline.
BRITSPINE 2016
Paul Davies
Is the senior member in the spinal
surgical unit at the University Hospital
of Wales. He was appointed as the first
fellowship trained spinal surgeon in
South Wales in 1997. The department
now has 7 spinal surgeons. Paul,
together with his colleagues, have
been responsible for educating and training over 50 fellows
in spinal surgery who have gone on to be established
consultants. His clinical experience includes the treatment
of all spinal pathologies from the cervical to the sacrum and
he has been dealing with scoliosis patients for 20 years. Paul
was the host chair of BritSpine 2006 in Cardiff. In the last
few years, Paul has been involved with charity spinal visits to
Zambia, where he has operated with a team of volunteers on
children with various spinal pathologies including scoliosis
and TB of the spine. He has a keen interest in teaching and
training (courses are run in Cardiff on a regular basis). He
has a particular expertise in dealing with complex revision
surgery and deformity in both children and adults. Paul has
been on the Executive of the British Scoliosis Society and is
interested in clinical research.
environment as Project Director for a PCT Turnaround
Programme. Further commissioning roles included leading
the strategy and planning function in a PCT and the primary
care, commissioning and reform agenda during a time of
significant change in commissioning structures. As a qualified
Programme and Project Manager, Sally also led both the
Long Term Conditions and Urgent Care Programmes in one
of the largest PCTs in the country. Her current role includes
leading the quality surveillance programme for specialised
commissioning including comprehensive and targeted peer
review visits to specialised commissioned services and all of
cancer services.
Stephen Eisenstein
Born in Randfontein (gold mining town
near Johannesburg), South Africa. His
medical training was at the University
of Witwatersrand, Johannesburg 1968.
His medical and surgical internship was
at Edendale Hospital, Pietermaritzburg
1969. Orthopaedic surgery specialist
training in Witwatersrand University
Hospitals.
• Registrars’ Prize, South African Orthopaedic Association
Jamie Day
• President’s Medal, South African Orthopaedic Association
Is a healthcare finance and information
specialist with extensive senior
strategic and operational NHS
experience. He left academic research
to lead an NHS Informatics Shared
Service team on behalf of 6 PCTs for a
number of years before commencing
work as a consultant contributing to
business-process and service improvement programmes,
coding and financial validation reviews and demand and
financial modelling projects for healthcare economies
across England. During the past couple of years, Jamie has
supported two national programmes – the NHS England
long-term condition Year of Care commissioning programme
and the Department of Health Getting It Right First Time
(GIRFT) programme. As part of this latter programme, Jamie
has contributed to a number of dashboards and reports
specifically targeted at understanding spinal services. He
updated the National Spinal Taskforce report (first developed
by Ashley Cole) and took a major role in developing the
Getting It Right First Time elective orthopaedics report for
Professor Tim Briggs (which contained a section on spinal
services). Jamie is currently working with Mike Hutton and
Nick Phillips on developing GIRFT data packs for spinal
services and neurosurgery services (respectively) to support
these clinical leads undertake peer-to-peer discussions with
each hospital in England who deliver these services.
• Fellow of the Royal College of Surgeons, Edinburgh 1973
Sally Edwards
Qualified as a nurse and a midwife
and spent 12 years in clinical
practice before developing her
career in general management and
quality assurance at a national level.
Following a stint at the Commission
for Health Improvement (CHI) she
returned to the commissioning
BRITSPINE 2016
• Visiting Fellow in Spine Surgery at Robert Jones and Agnes
Hunt Orthopaedic Hospital, Oswestry 1976
• Sir Robert Jones Gold Medal and Prize - Combined
Meeting of English Speaking Orthopaedic Associations,
London 1976
• Principal Orthopaedic Surgeon, University of the
Witwatersrand 1977-1980
• PhD 1980 University of the Witwatersrand - “The Human
Lumbar Vertebral Canal”
• Private practice Johannesburg and part-time Consultant
Spine Surgeon, Natalspruit General Hospital 1980-1985
• Consultant Spine Surgeon at Robert Jones and Agnes Hunt
Orthopaedic Hospital, Oswestry 1985–2015
Research includes 90 publications in peer-reviewed journals
(with multiple co-authors), Oswestry Disability Index (with
Judith Couper and John O’Brien), Basic Science: Back Pain
and Disc Degeneration (with Professor Sally Roberts), Clinical:
Deformity, Cancer, Infection, Inflammation. Book “Spinal
Disorders for Beginners”.
Mike Gibson
Consultant Spinal Surgeon with a
major interest in the treatment of
scoliosis. He was appointed in 1990
to the Orthopaedic Department in
Newcastle-upon-Tyne and is now
based at the Royal Victoria Hospital.
He trained in orthopaedics in Leicester
and the northern region with spinal
fellowships in Nottingham (1984-85) and Adelaide (198990). National roles have included membership of the BSS
Executive Committee (1996-69), Chairman of AO Spine
Education Group (2001-04) and President of BSS (2010-12).
He is one of the founding members of UKSSB.
24
Charles Greenough
Qualified from Queens’ College,
Cambridge and University College
Hospital, London. He trained as an
orthopaedic surgeon at the Royal Free
Hospital, London and the Royal National
Orthopaedic Hospital, Stanmore.
Specialist spinal training was also
undertaken at the Royal Adelaide Hospital, South Australia.
He is now a Consultant Spinal Surgeon at the James Cook
University Hospital, Middlesbrough. He is also Clinical Director
of the Golden Jubilee Regional Spinal Cord Injuries Centre
and Professor of Spinal Studies at the University of Durham.
Appointed as National Clinical Director for Spinal Disorders in
April 2013, his vision is to promote a seamless care pathway
for patients with low back pain or sciatica across the NHS to
reduce long-term disability and multiple ineffective therapies.
Colin Howie
Trained at Edinburgh and Exeter and
was originally appointed as a consultant
in Inverness. In 1995 he moved to
Edinburgh (Princess Margaret Rose
Orthopaedic Hospital) to continue the
renowned arthritis service and to provide
a specialist arthroplasty service. Clinical
and research interests are focused on joint replacement,
revision joint replacement (hip, knee, ankle, shoulder and
elbow) and arthritis surgery in general with a special interest
in patient derived outcomes. He was President of the British
Orthopaedic Association (BOA) from 2014-2015.
Mike Hutton
Appointed as a Consultant Spine
Surgeon at The Royal Devon and Exeter
Hospital in 2007 and was appointed as
clinical lead in spine surgery in 2014. His
specialist training was on the East Anglian
Orthopaedic rotation. He undertook a
combined neurosurgical/orthopaedic
spinal fellowship at Addenbrooke’s Hospital, Cambridge,
Royal National Orthopaedic Hospital Stanmore and Norfolk
and Norwich University Hospital. Following this he went on a
travelling fellowship at Vancouver General Hospital and Harbour
View Hospital, Seattle. Mike has a wide practice in spine surgery
undertaking complex spine procedures in all areas of the spine
with varied pathological conditions including paediatric and
adult spine deformity. He is currently an elected member of the
Executive of the British Association of Spine Surgeons (BASS) as
the audit and British Spine Registry Lead and Spinal Lead for
the Department of Health Clinically Led Quality and Efficiency
Programme.
Gerard Martin QC
disorders. In the way his career has developed both at the
junior bar and in silk, he has been instructed almost exclusively
by those acting for Claimants (including those employed in
the military), save for one or two occasions when insurance
companies have sought his assistance. The majority of his work
over the past 15 years in silk has been for clients with severe
brain injuries, be they adults or children, the injuries resulting as
the consequence of accidents or by way of clinical negligence.
Each case of severe brain injury is unique and experience has
taught him that it is unwise to generalise about outcomes,
much depends upon the individual and the support they
receive. Practising in this speciality has meant that the experts
on both sides of the litigation divide are known to him, as are
the centres of excellence for rehabilitation of the brain injured.
Ensuring the inclusion of the client who may lack capacity to
make decisions for himself re his claim, or in the management
of his affairs, is vital and integral to the way he works. Visiting
the client and his or her family at their home, hospital or in his
rehabilitation unit is essential so as to gain a better understanding
of the important issues in their lives.
This means that he has visited most parts of England and Wales
in the course of his work. Gerard has chambers in Liverpool,
Manchester, Leeds, London and Birmingham if a meeting in an
office environment is required. His approach to this work is to
encourage and promote teamwork between client, solicitor,
counsel and their expert advisors. He always wishes to be
instructed at the outset of the case if possible, so as to influence
its direction and choice of experts to assist the client. He uses
the same approach outlined above to other areas of his practice
which includes managing claims for spinal injury, amputees,
complex regional pain syndrome and other somatoform
disorders. Most cases settle by negotiation rather than trial in
court. One of his particular interests is the preparation for and
conduct of the negotiations which may lead to the conclusion of
the case. His aim is to anticipate well in advance the arguments to
be deployed against his client, to gather the evidence and serve
in advance of the meeting so as to defeat those arguments.
Professor Sir Bruce Keogh
Is NHS England’s Medical Director and
professional lead for NHS doctors. He
is responsible for promoting clinical
leadership, quality and innovation.
Formerly, Sir Bruce had a distinguished
career in surgery. He was Director
of Surgery at the Heart Hospital and
Professor of Cardiac Surgery at UCL. He has been President
of the Society for Cardiothoracic Surgery in Great Britain and
Ireland, Secretary-General of the European Association for
Cardio-Thoracic Surgery, International Director of the US Society
of Thoracic Surgeons and President of the Cardiothoracic
Section of the Royal Society of Medicine. He has served as a
Commissioner on the Commission for Health Improvement
(CHI) and the HealthcareCommission. He was knighted for
services to medicine in 2003.
Former Chair of Northern Circuit, Medical
Law Association, former recorder,
Accredited Mediator. Specialist in brain
injury cases - spinal injury cases for adults
and children. Other specialties include
claims for amputees, pain and somatoform
25
BRITSPINE 2016
Richard J Nelson
Catherine O’Connell
Is the immediate Past President of
the Society of British Neurological
Surgeons having previously served as
Vice-President of the SBNS, Secretary
to the Neurosurgical National Selection
Board and Chairman of the Specialist
Advisory Committee in Neurosurgery.
He has been closely involved in the
development of the neurosurgical curriculum, neurosurgical
training programmes and selection for post-graduate training in
the United Kingdom. He is currently Chair of the Neurosurgical
National Audit Programme.
Catherine has extensive experience of
leading commissioning organisations
with a strong belief that working with
clinical leaders, placing clinicians at the
centre of decision making is paramount
for commissioning excellent responsive
services. Catherine started her career in
General Practice management and moved
on to work in both commissioning and community services
roles in PCGs and PCTs. She has previously been CEO for West
Essex PCT and Chief Operating Officer for the Midlands and East
Specialised Commissioning Group. Catherine was Director of
Commissioning, responsible for assuring NHS England’s direct
commissioning functions in the Midlands and East. Catherine
began her current role as Director of Specialised Commissioning
for the Midlands and East Region on 1 April 2015.
Colin Nnadi
Consultant Spine Surgeon at the Oxford
University Teaching Hospitals. He is
Chair of the BASS Research Committee.
His spine training was at the Royal
National Orthopaedic Hospital,
Stanmore, Norfolk and Norwich
University Teaching Hospital and
Queen’s Medical Centre, Nottingham. His research interests
are in paediatric deformity. He is Chief Investigator for 2 clinical
trials on scoliosis. He recently published a book on EOS (2015).
His work on a “Cost analysis of MAGEC rods” was used as a
template for the NICE economic appraisal. He is convener of
the Oxford EOS meetings and has recently been involved in
formulating guidelines on VTE in spinal surgery.
Hilali Noordeen
Is a Consultant Orthopaedic and
Spinal Surgeon at the Royal National
Orthopaedic Surgeon in London and
Adjunct Professor of Spinal Surgery at
the National University of Malaysia, Kuala
Lumpur. He had his undergraduate
education at the University of Oxford
at Balliol College where he was also the President of the
Oxford Union. He trained at St Thomas’, St Bartholomew’s,
University College and the Middlesex Hospitals, as well as the
Royal National Orthopaedic Hospital, where he was awarded
the Walter Mercer Gold medal for his performance at the
intercollegiate FRCS(Orth) prior to his appointment as Senior
Lecturer in Orthopaedics to the Institute of Orthopaedics UCL in
1994. He was subsequently appointed as a Consultant to the
Middlesex Hospital (1995-1998), Great Ormond Street Hospital
for Children (1995-2010) and the Royal National Orthopaedic
Hospital, London (1995 to date). He has a particular interest in
Early Onset Scoliosis and is a former Executive member of the
BSS. He is ex-Chair of the Fellowship Committee of the SRS and
is a member of the Ethics Committee. He has authored several
publications in the area of spinal deformity and chapters in
textbooks of spinal surgery. BRITSPINE 2016
Nick Peirce
Works both as a Consultant in Sport and
Exercise Medicine at QMC, with an NHS
musculoskeletal/sports injury clinic and
in elite sport as Chief Medical Officer for
the England and Wales Cricket Board
and local teams including Nottingham
Forest Football.
He was originally
trained in Family Medicine and moved into Sport and Exercise
Medicine in 1995. His trained has included an MSc in Sports
Medicine in 1996, a 2-year Lectureship at Nottingham University
and subsequent Overseas Sports Medicine Fellowship at the
Australian Institute of Sport. Since 1997 he has worked as CMO
for GB World Class Canoeing Programme and for LTA Great
Britain Davis Cup team 2001-2007. In 2003 he became the lead
physician at the English Institute of Sport at Loughborough
University until moving to cricket full-time. Nick has attended
Sydney and Athens Olympics and Commonwealth Games and
has continued to be the lead sports physician for Nottingham
Forest Football Club since 2001. He is currently the training
programme director for SEM in East Midlands, sits on the Faculty
for SEM and SAC and chairs national recruitment and workforce
planning. Other activities include editorial Boards for BJSM and
CJSM, ICC Medical Committee and continues to be actively
involved in research and injury surveillance. He supervises PhDs
at Oxford, Birmingham and Loughborough University in fast
bowlers spinal injuries, retired cricketers and OA, concussion,
helmet design and head injuries and stress fractures and
bone metabolism in athletes. His clinical interests include all
musculoskeletal conditions, development of non-surgical MSK
pathways and has particular experience in ultrasound guided
and interventional procedures.
Allyson Pollock
Is Professor of Public Health Research
and Policy at Queen Mary, University
of London and author of “NHS plc: the
Privatisation of Our Health Care”.
26
John Powell
Simon Tait
Is a Consultant Spinal Surgeon based
at the Ipswich Hospital in the east of
England. John was appointed, along
with his recently retired colleague, David
Sharp, in 1988. Together they have
been involved with the development
of the spinal department which is now
a hub centre that includes Ipswich,
Chelmsford, Colchester and Bury St Edmunds. John is one of 9
spinal surgeons at this hub regional service and they combine
with Cambridge and Norwich to service the spinal needs of
East Anglia. John initiated the Ipswich spinal surgery consent
pathway in 2002. It has been widely copied with copyright
released on the procedure specific information booklets and
consent forms. The content has developed and modified
according to changing surgical and legal demands with a
3-yearly review of all information. Last year BASS set up a
working party to address this issue as a nationwide initiative
and asked John to chair the group. It will be available for
newly appointed surgeons or colleagues who do not have a
formal system for consent. It will be researched, updated and
evidenced on a regular basis by the working party under BASS
sponsorship.
Is a partner and the Head of Health Law
at national law firm, Browne Jacobson
LLP. He qualified as a solicitor in 1990
and has spent his whole career acting
for both public and private health sector
clients. Simon handles a caseload
of complex inquests and clinical
negligence claims, acting exclusively
for defendants, including NHS Trusts, individual health
professionals and indemnifiers such as the Medical Protection
Society. He also advises on issues such as confidentiality and
disclosure of medical records, mental health law and consent
to treatment. Simon has a particular interest in the provision of
training to health sector professionals and regularly provides
training sessions on a wide variety of topics.
Am Rai
Qualified from Southampton University
in 1990 and completed his specialist
training in Wessex. He attended spinal
fellowships in Australia, Europe, America
and South Africa. He was appointed as
Consultant Spinal Surgeon at Norfolk
and Norwich University Hospital in
2001. He has a varied practice including
scoliosis surgery. His is President of the British Association of
Spine Surgeons (BASS) and Foundation Programme Director.
He is also director of Spine Aid, a charity which raises money
to help treat disadvantaged patients in the developing world
who have spinal problems and disabilities. Am is married to
Jess and they have 2 teenage children. He enjoys keeping fit,
golf and travel.
Lisa Roberts
Is a clinical academic based in
Southampton. After qualifying from St
Thomas’ Hospital, London, she worked
clinically while gaining her PhD from
the University of Southampton. She
is an associate professor with £3.5m
current research running alongside her
National Institute for Health Research
senior clinical lectureship. Lisa works clinically as a consultant
physiotherapist and leads the clinical effectiveness agenda
for 8 professions at the University Hospital Southampton NHS
Foundation Trust. In November 2014, Lisa was appointed
President of the Society for Back Pain Research for 2 years
(having been secretary from 2007-9). She was a Trustee of the
charity BackCare for 20 years and also chaired the research and
education committees.
27
Alistair Thompson
• Qualified Birmingham 1965
• Visiting Research Fellow University of
California, San Diego 1968-1969
• CCST Orthopaedic Surgery 1976
• Lecturer Department of Orthopaedic
Surgery, Hong Kong 1976
• Member of the Council of the British
Orthopaedic Association 1998-2000
• Member of the Editorial Board JBJS 2001-2004
• President of British Scoliosis Society 2003
• Emeritus Fellow Scoliosis Research Society
• Intercollegiate examiner and in Hong Kong and Singapore
1996-2003
• Appointed Consultant Orthopaedic Surgeon, Royal
Orthopaedic Hospital, Birmingham and Birmingham
Children’s Hospital 1977-2007 and continued as an Honorary
Visiting Consultant until 2013
Thanos Tsirikos
• MD: 1994
• Orthopaedic Qualification (Honours):
2000
• FRCS (London-England): 2004
• PhD (Honours): 2007
• Fellowship in Paediatric
Orthopaedics/Spine: Alfred I duPont
Hospital for Children, USA
• Fellowship in Spinal Surgery: Great Ormond Street Hospital/
Royal National Orthopaedic Hospital-Stanmore
• Fellowship in Spinal Surgery: Royal Infirmary of Edinburgh/
Royal Hospital for Sick Children, Edinburgh
• Consultant since 2004/Scottish National Spine Deformity
Centre/Edinburgh
• Best Doctor Award in 2011
• Finalist on 3 Health Professionals Awards
• Research: 126 oral/poster presentations; 11 chapters; 84
peer reviewed publications
• 2 Scholarships and several Best Paper Awards (including
British Scoliosis Society and Scoliosis Research Society)
• Educational Chair/British Scoliosis Society
• Associate Editor: Spine Deformity; reviewer for 8 Journals
BRITSPINE 2016
John Webb
Frances M K Williams
Trained in spinal surgery from 1973 at the Robert Jones and
Agnes Hunt Orthopaedic Hospital, Oswestry during which
time he worked in Switzerland for 6 months and the USA for
one year, becoming a Consultant in Orthopaedics in 1978. He
has specialised in spinal surgery and he is now an Honorary
Emeritus Consultant Spinal Surgeon in
the NHS.
Reader and Hon Consultant
Rheumatologist at the Department
of Twin Research and Genetic
Epidemiology, King’s College London.
Frances qualified in medicine with
distinction from Imperial College in
1992 and undertook her PhD in the
lab while training in Rheumatology in
South Thames. She obtained a Wellcome Trust intermediate
fellowship in 2007 which facilitated the transition in research
to genetic epidemiology. The broad interest of her group is
the genetic epidemiology of common complex traits with the
main focus on chronic pain syndromes, such as low back pain
and intervertebral disc degeneration.
He was the Founder and Past Director
of the Centre for Spinal Studies and
Surgery at the University Hospital,
Nottingham. He has published 107
peer-reviewed articles which are
predominantly related to spinal surgery,
together with participation in book
chapters and is co-author of 2 spinal
books. He is a Past-President of the British Scoliosis Society
and member of numerous spine societies. He is a reviewer
of the 2 major spine journals “Spine” and “European Spine
Journal”.
Lester Wilson
Is a Consultant Spine Surgeon at the
Royal National Orthopaedic Hospital
in Stanmore. His practice deals with
complex degenerative conditions of
the lumbar spine and he also runs the
regional spinal infection service. I trained
as a Spine Fellow in Nottingham and
have an interest in minimally invasive
spine surgery. I have taught MI spinal surgical techniques at
over 30 national and international cadaver workshops.
BOA Annual Congress 2016
13th - 16th September, Belfast Waterfront
Clinical Leadership & Engagement
congress.boa.ac.uk #BOAAC
Non-member Registration Opens 1st June 2016
*FREE
Member
Registration
Opens
4th April
(*Terms & Conditions apply, see website for details)
Sessions will include:
• GIRFT • Tariff and Coding • Consent • Commissioning • Leadership • NJR • NHFD • Simulation
• Patients • Medico-Legal • Political Update • Trauma • Spines • Research • Medical Students
• Best of the Best • Charnley Lecture • Adrian Henry Lecture • Naughton Dunn Lecture
• Howard Steel Lecture • Robert Jones Lecture • King James IV Professorship Lecture
BRITSPINE 2016
28
Britspine 2016 Nottingham Training Day
Tuesday, 5th April 2016 Nottingham Anatomy Training Centre
08.15-08.45
Registration – Spinal Conference Room, Queen’s Medical Centre, West Block, D Floor, Nottingham
08.30-08.45
Cadaver Dissections – Anatomy Department
Introduction and Welcome – Nottingham and The Queen’s Medical Centre
Nasir Quraishi
09.00-10.45
Posterior Cervical Exposures
Moderator: Khalid Salem
Posterior – cervical lateral mass/pedicle screws
Posterior – cervical decompression/foraminotomy techniques
Vertebral artery dissection
Posterior Thoracic Exposures
Moderator: Masood Shafafy
Thoracic pedicle screws
Osteotomy techniques
10.45-11.00
11.00-12.30
Coffee
Posterior Lumbar Exposures
Moderators: Zdenek Klezl/Masood Shafafy
Decompression/discectomy; lumbar pedicle screws; interbody access – PLIF/TLIF
Osteotomy techniques
12.30-13.30
13.30-14.45
Lunch
Anterior Cervical Exposures
Moderator: Omar Gabbar
Anterior cervical approaches
Left versus right-sided approaches
Cervical discectomy/corpectomy techniques
Vertebral artery dissection
14.45-15.00
15.00-17.00
Tea
Anterior Thoracic/Lumbar Exposures
Moderators: Masood Shafafy/Zdenek Klezl
Direct lateral/anterolateral/anterior approaches – ALIF/XLIF/OLIF
Mobilisation of vessels
19.30-22.00
Trainees dinner with faculty at “True Barbecue” – the best burger in Nottingham
Table 1
(NuVasive)
Faculty: Stuart James
Scrub nurse: Steph C
29
Table 2
Table 3
(Globus)
(Stryker)
Faculty: Masood Shafafy/
Faculty: David Marks/
Stuart Blagg
Jwalant Mehta
Scrub nurse: Trish
Scrub nurse: Kathy
Table 4
(Microscope/Anatomy
Tutorials: Alphatec)
Faculty: Khalid Salem/
Ali Rajabian
Scrub nurse: Michaela
BRITSPINE 2016
Britspine 2016 Nottingham Masterclass
Tuesday 5 April 2016 Nottingham Conference Centre
13.30-13.50
Registration – Adams Room, 1St Floor, Nottingham Conference Centre
13.50-14.00
Introduction And Welcome
Chairs: Mike Grevitt/Phil Sell
14.00-14.05
Case Presentation 1: Congenital Spine Stenosis Phil Sell
Moderator: Nick Haden
14.05-14.25
Case Discussion (Groups)
14.25-14.40
Group Presentations
14.40-14.45
Case Solution: Phil Sell
14.45-14.55
Expert Opinion And Take Home Message: Sashin Ahuja
14.55-15.00
Evaluation
15.00-15.05
Case Presentation 2: Spondylolisthesis John Hutchinson
Moderator: Bob Crawford
15.05-15.25
Case Discussion (Groups)
15.25-15.40
Group presentations
15.40-15.45
Case solution: John Hutchinson
15.45-15.55
Expert opinion and take home message: Sean Molloy
15.55-16.00
Evaluation
16.00-16.15
Coffee
16.15-16.20
Case Presentation 3: Infected Pseudoarthrosis Lumbar Fusion Mike Grevitt
Moderator: Mark Thomas
16.20-16.40
Case discussion (groups)
16.40-16.55
Group presentations
16.55-17.00
Case solution: Mike Grevitt
17.00-17.10
Expert opinion and take home message: Sashin Ahuja
17.10-17.15
Evaluation
17.15-17.20
Case Presentation 4: Proximal Junctional Kyphosis Bob Crawford
Moderator: John Hutchinson
17.20-17.40
Case discussion (groups)
17.40-17.55
Group presentations
17.55-18.00
Case solution: Bob Crawford
18.00-18.10
Expert opinion and take home message: Sean Molloy
18.10-18.15
Evaluation
19.30
BRITSPINE 2016
Faculty dinner with Gold Sponsors at Hart’s Restaurant
30
BritSpine 2016 Nottingham Committee Meetings
Tuesday, 5th April 2016 Nottingham Conference Centre
12.30
13.00-16.00
16.00
16.00 - 18.00
16.00 - 18.00
LUNCH
Potter Room Level 1
United Kingdom Spine Societies Board Meeting (UKSSB)
Potter Room Level 1
TEA
Potter Room Level 1
British Association of Spine Surgeons (BASS) Executive Meeting
Booth Room Level 1
British Scoliosis Society (BSS) Executive Meeting
Green Room Level 1
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2/12/2016 12:25:29 PM
Programme Outline and Key
Address
BASS/SBPR
Debate
Keynote
Special Posters
BASS
Best of Show Papers
Grand Masters
Perspectives on Current Healthcare
Spine Strategy 2020
BASS/BSS (Infection/Tumour)
BSR
Instructional Session
SBPR
SRS/BSS
BASS/BSS (Trauma/Tumour)
BSS
Interactive Discussion
Social
Workshops
Tuesday 5 April 2016
08.15-08.45
Registration – Trainees only
Spinal Conference Room, Queen’s Medical Centre
09.00-17.00
Training Day
Nottingham Anatomy Training Centre
19.30-22.00
Trainees’ Dinner
True Barbecue
13.30-13.50
Registration – Masterclass only
Nottingham Conference Centre
13.50-18.15
Masterclass
Adams Room
Exhibition set up
Levels 0 & 2
Lunch
Potter Room Level 1
13.00-16.00
UKSSB Meeting
Potter Room Level 1
16.00
BASS Executive
Booth Room Level 1
16.00
BSS Executive
Green Room Level 1
19.30
Faculty Dinner
Hart’s Restaurant
Registration
Nottingham Conference Centre
07.30 onwards
13.00
Wednesday 6 April 2016
07.45-08.45
Lecture Theatre 2
08.45-09.00
09.00-10.00
Opening Address
Papers
10.00-10.30
10.30-11.00
Lecture Theatre 4
BASS
BSS
Keynote Lecture
Coffee & Exhibition
11.00-12.30
Levels 0 & 2
Keynote Lecture
12.30-14.00
Lunch
Levels 0 & 2
12.30-14.00
Workshops
Level 2
14.00-16.00
Spine Strategy 2020
16.00-16.30 Coffee & Exhibition
Levels 0 & 2
16.30-17.30
Grand Masters of Spine
17.30-19.00 Workshops
Level 2
19.00-21.00 Welcome Reception/Speed Dating Foyer/Exhibition
33
BRITSPINE 2016
Programme Outline and Key
Address
BASS/SBPR
Debate
Keynote
Special Posters
BASS
Best of Show Papers
Grand Masters
Perspectives on Current Healthcare
Spine Strategy 2020
BASS/BSS (Infection/Tumour)
BSR
Instructional Session
SBPR
SRS/BSS
BASS/BSS (Trauma/Tumour)
BSS
Interactive Discussion
Social
Workshops
Thursday 7 April 2016
07.30-08.30 Registration
Nottingham Conference Centre
Lecture Theatre 2
08.30-10.10
SRS/BSS
10.10-11.00
Debate
Lecture Theatre 4
08.30-10.30
BASS/SBPR
10.30-11.00
British Spine Registry (BSR)
11.00-11.30 Coffee & Exhibition
Levels 0 & 2
11.30-12.30
BSS
Special Posters
12.30-13.00
Interactive Discussion
UKSSB SBPR Fellowships
13.00-14.00 Lunch
Levels 0 & 2
13.00-14.00 Workshops
Level 2
13.00-14.00 AOSpine session
Lecture Theatre 4
14.00-15.00
Perspectives on Current
Healthcare
15.00-16.10 Papers
Best of Show
16.10-16.40
Address SBNS & BOA Past
Presidents
16.40-17.25 General Meeting
UKSSB
17.30-18.45 Annual General Meeting
BASS
19.30 Coaches depart
Nottingham Conference Centre
20.00 Conference Dinner
Colwick Hall
Friday 8 April 2016
08.00-09.00 Registration
Nottingham Conference Centre
Lecture Theatre 2
Lecture Theatre 4
09.00-10.00 Papers
BASS/BSS (Infection/Tumour)
SBPR
10.00-10.30
Keynote Lecture
10.30-11.00 Coffee & Exhibition
Levels 0 & 2
11.00-12.00 Papers
BASS/BSS (Trauma/Tumour)
12.00-12.45
Instructional Session
12.45-13.00
Prizes
13.00-13.30 Lunch
Levels 0 & 2
13.30-17.00 Patients’ Afternoon
Adams Room (2nd floor)
14.00-17.00 Spinal Care Project
Bowden Room (2nd floor)
BRITSPINE 2016
34
Programme
BRITSPINE 2016 NOTTINGHAM
Wednesday 6 April 2016 - Nottingham Conference Centre
LECTURE THEATRE 2
07.45-08.45
08.45-09.00
09.00-10.00
REGISTRATION
OPENING
ADDRESS
NOTTINGHAM CONFERENCE CENTRE
PAPERS
British Association of Spine Surgeons
(BASS)
Am Rai/Stuart Blagg
Chairs
09.00-09.10
09.10-09.20
LECTURE THEATRE 4
Nasir Quraishi
British Scoliosis Society (BSS)
Bob Crawford/Benny Dahl
(1) Use of antibiotic and incidence of
antibiotic associated diarrhoea in patients
with spinal cord injuries: a UK National Spinal
Injury Centre experience
(7) Analysis of segmental mobility
following a novel posterior apical shortsegment correction for adolescent
idiopathic scoliosis
Samford Wong (Stoke Mandeville Hospital)
Colin Nnadi (Oxford University Hospitals
Foundation NHS Trust)
(2) Management of deep spinal infections in
a tertiary centre
(8) Clinical and radiologic outcome
from 360-degree lumbar spondylodesis
using porous tantalum cages in spinal
reconstruction for degenerative lumbar spine
deformity
Wing Sum Lao (University of Birmingham
Medical School)
Darren Lui (Royal National Orthopaedic
Hospital)
09.20-09.30
(3) Spontaneous epidural infections: a
prospective patient reported review at a
single tertiary centre
Saffwan Mohamed (The Walton Centre NHS
Foundation Trust)
09.30-09.40
(4) The safety, efficacy and cost-effectiveness
of intraoperative cell-salvage in metastatic
spine tumour surgery
Mahmoud Elmalky (Salford Royal NHS
Foundation Trust)
09.40-09.50
09.50-10.00
(9) Health related quality of life in patients
undergoing cervico-thoracic osteotomies
for fixed cervico-thoracic kyphosis in
patients with ankylosing spondylitis
Silviu Sabou (Queens Medical Centre,
Nottingham University Hospitals NHS Trust)
(10) Pre- and post-operative 3D gait
analysis in high-grade spondylolisthesis
Sudarshan Munigangaiah (Alder Hey
Children’s NHS Foundation Trust)
(5) Flowcytometric evaluation of
intraoperative salvaged blood filtered with
leucocyte depletion filter in metastatic spine
tumour surgery
(11) Efficacy of SpineSage tool for
assessing the expected complication
rates in adult spine deformity surgery –
preliminary results
Naresh Kumar (National University Health
System, Singapore)
Marcin Czyz (Queens Medical Centre,
Nottingham University Hospitals NHS Trust)
(6) Evaluation of the safety of using
intraoperative salvaged blood in metastatic
spine tumour surgery: using Microwell
technique
(12) Sacral osteotomies for correction of
high pelvic incidence
Nasir Quraishi (Queens Medical Centre,
Nottingham University Hospitals NHS Trust)
Naresh Kumar (National University Health
System, Singapore)
35
BRITSPINE 2016
Programme
10.00-10.30
10.30-11.00
11.00-12.30
12.30-14.00
KEYNOTE
LECTURE
Genetic Epidemiology of Low Back Pain
Dr Frances Williams (Consultant Rheumatologist)
Introduction
Lisa Roberts (SBPR President)
COFFEE & EXHIBITION
KEYNOTE
LECTURE
Chair
Informed Consent in the post-Montgomery era
Mike Grevitt
11.00-11.15
Montgomery vs Lanarkshire Health Board - The facts of the case
Implications of the Supreme Court Ruling
11.15-11.30
The surgeon’s perspective
Informed spinal consent after Montgomery - A BASS sponsored initiative
John Powell
11.30-11.45
The defence solicitor’s perspective
Montgomery and the Law on informed consent from reasonable doctor to reasonable
patient
Simon Tait
11.45-12.00
The claimant’s barrister’s perspective
Cumulative causes
Gerard Martin, QC
12.00-12.25
Panel discussion/Q&As
12.25-12.30
Summary
LUNCH & EXHIBITION
WORKSHOPS
14.00-16.00
UKSSB SPINE CARE STRATEGY 2020
DELEGATE SUGGESTIONS
Pre-reading: In order for you to get the most out of this session and to enable you to
contribute actively, it would be useful if you are familiar with the documents listed below.
The speakers have been asked to assume that you will have read these documents and not
to re-cover the content in their presentation. These may all be found on the UKSSB website
www.ukssb.com in the “reference documents” section.
National Low Back and Radicular Pain Pathway Specific
(previously known as Spinal Pathfinder Project)
Regional Spinal Networks Template
Spinal Taskforce Reports 2010, 2013
Generic
Getting It Right First Time (GIRFT)
Chair
14.00-14.05
14.05-14.25
14.25-14.30
Tim Pigott/Mel Grainger
Introduction Alistair Stirling
What are we doing and how much is it costing?
Getting It Right First Time (GIRFT – Spine) - Mike Hutton/Jamie Day (GIRFT Team)
Discussion
How is it paid for?
14.30-14.40
The commissioning interface and how surgeons should relate to it
Catherine O’Connell (Commissioner)
BRITSPINE 2016
14.40-14.45
Discussion
14.45-15.00
How can spinal services be improved?
1) National Low Back and Radicular Pain Pathway Professor Charles Greenough (National Clinical Director for Spinal Disorders)
15.00-15.05
Discussion
36
Programme
15.05-15.20 2) Regional Spinal Networks
Ashley Cole (Chair - Complex Spinal Surgery Clinical Reference Group)
15.20-15.25 Discussion
15.25-15.35
Are we making a difference?
Spinal Peer Review – Sally Edwards (Peer Review - NHS Improving Quality)
15.35-15.40 Discussion
Panel discussion
15.40-15.55 Speakers with Presidents of Spine Societies
Am Rai (BASS), Robert Crawford (BSS), Lisa Roberts (SBPR), Rick Nelson (SBNS)
15.55-16.00 Summary
16.00-16.30
COFFEE & EXHIBITION
16.30-17.30
GRANDMASTERS OF SPINE
Chairs
Hossein Mehdian/Mike Grevitt
16.30-16.45
How the Rheumatoid Neck changed my Clinical Practice Alan Crockard
16.45-17.00
One Bone Stephen Eisenstein
17.00-17.15
Tuberculosis of the Spine Alistair Thompson
17.15-17.30
The Operation that Changed my Life John Webb
17.30-19.00
WORKSHOPS
19.00-20.30
WELCOME RECEPTION – Foyer/Exhibition, Nottingham Conference Centre
37
BRITSPINE 2016
Programme
Thursday 7 April 2016 - Nottingham Conference Centre
LECTURE THEATRE 2
07.30-08.30
REGISTRATION
08.30-11.00
Chairs
LECTURE THEATRE 4
NOTTINGHAM CONFERENCE CENTRE
Scoliosis Research Society (SRS) and
British Scoliosis Society (BSS)
British Association of Spine Surgeons
(BASS) and Society of Back Pain
Research (SBPR) combined papers
Benny Dahl/Hossein Mehdian
Ciaran Bolger/Lisa Roberts
08.30-08.50
08.30-08.40
Reducing Risk in Scoliosis Surgery
(13) Predictors of self-management in
patients with chronic low back pain: study
protocol
John Dormans (USA)
Anirban Banerjee (University of Nottingham)
08.50-09.10
08.40-08.50
Quality of Life in Adult Spinal Deformity
(14) Patient reported outcome measures:
the accuracy of patient reported revision
spinal surgery
Ferran Pellisé (Spain)
Elmajee Mohammed (Salford Royal NHS
Foundation Trust)
09.10-09.30
08.50-09.00
Techniques and Strategies in the Surgical (15) The effect of classification-based
Management of Coronal and Sagittal
cognitive functional therapy on spinal
Unbalanced Deformities
kinematics and function in subgroups of
chronic low back pain
Daniel Chopin (France)
Liba Sheeran (Cardiff University, School of
Healthcare Sciences)
09.30-09.50
09.00-09.10
What’s New in Scoliosis Surgery?
(16) Improving MRI diagnosis following
whiplash injury by routine imaging of the
cranio-cervical junction in addition to the
cervical spine
Benny Dahl (Denmark)
Francis Smith (Medserena Upright MRI Centre,
London)
09.50-10.10
09.10-09.20
Discussion
(17) Early results of hybrid cervical disc
arthroplasty - results from a single centre
All
Shoaib Khan (University Hospital of North
Tees)
09.20-09.30
(18) Predictive factors of outcome
following ACDF – a study of 611 patients
Thomas Finnigan Salford Royal NHS
Foundation Trust)
09.30-09.40
(19) ‘I think positivity breeds positivity’: a
qualitative exploration of the role of family
members in supporting those with chronic
musculoskeletal pain to stay at work
Serena Bartys (University of Huddersfield)
BRITSPINE 2016
38
Programme
09.40-09.50
(20) A systematic literature review
of pain and disability outcomes of
pain neuroscience education in the
management of chronic low back pain
Lianne Wood (Queens Medical Centre,
Nottingham University Hospitals NHS Trust)
09.50-10.00
(21) Clinical usefulness and safety of
selective lumbar nerve root blocks
Grzegorz Rudol (Leeds General Infirmary)
10.00-10.10
(22) The differential effects of
norepinephrine and dopamine on
cerebrospinal fluid pressure and spinal
cord perfusion pressure after acute human
spinal cord injury
Farhaan Altaf (University of British Columbia
and Vancouver General Hospital, Canada)
10.10-10.20
(23) Is frailty prevalent in older people
admitted to hospital with osteoporotic
vertebral fragility fractures (VF)?
Lihxuan Goh (Queens Medical Centre,
Nottingham University Hospitals NHS Trust)
10.20-10.30
(24) Is the thoracolumbar injury
classification and severity score (TLICS)
applicable to UK practice?
James Tomlinson (Leeds General Infirmary)
10.10-11.00
10.30-11.00
The ‘MAGEC’ Debate: Trick or Treat
British Spine Registry
“This house believes that magnetically
controlled growing rods represent ‘state of
the art’ treatment for early onset scoliosis”
Mike Hutton (BASS Registry and Audit Lead)
Moderator: David Marks
FOR:
Hilali Noordeen/Colin Nnadi
AGAINST:
Sashin Ahuja/Mike Gibson
11.00-11.30
COFFEE & EXHIBITION
11.30-12.30
Chairs
British Scoliosis Society (BSS)
Special Posters
Ferran Pellisé/Masood Shafafy
Harshad Dabke/David Choi
11.30-11.40
(25) Povidone-Iodine (PVI) has a profound
effect on in vitro osteoblast proliferation
and metabolic function and inhibits their
ability to mineralise and form bone
Matthew Newton Ede (Royal Orthopaedic
Hospital, Birmingham)
39
11.30-11.35
(SP1) Berry’s ligament and the inferior
thyroid artery as reliable anatomical
landmarks for the recurrent laryngeal
nerve (RLN) - a fresh cadaveric study
relevant to the cervical spine
Ali Rajabian (Queens Medical Centre,
Nottingham University Hospitals NHS Trust)
BRITSPINE 2016
Programme
11.40-11.50
11.35-11.40
(26) Comparison of primary and
conversion surgery with magnetically
controlled growing rods in children with
early onset scoliosis
(SP2) Right versus left sided exposures of
the recurrent laryngeal nerve (RLN) and its
branches - a fresh cadaveric study relevant
to the cervical spine
Pavlos Panteliadis (Oxford University
Hospitals Foundation NHS Trust)
Ali Rajabian (Queens Medical Centre,
Nottingham University Hospitals NHS Trust)
11.50-12.00
11.40-11.45
(27) Estimated x-ray exposure and
additional cancer risk during surgical
treatment of scoliosis in the growing spine
(SP3) Comparing patient outcome
measures in a cohort of patients who
underwent anterior cervical discectomy
and fusion (ACDF) versus cage-plate ACDF
Peter Loughenbury (Leeds General Infirmary)
Shrijit Panikkar (Salford Royal NHS
Foundation Trust)
12.00-12.10
11.45-11.50
(28) Is there a correlation between gross
motor function classification system
(GMFCS) score and scoliosis in patients
with cerebral palsy? A systematic review
(SP4) Missed cervical spine injuries.
A national survey of the practice of
evaluation of the cervical spine in
obtunded patients
Lara E McMillan (University Hospital of
Wales)
Simon Craxford (Royal Derby Hospital)
12.10-12.20
11.50-11.55
(29) Surgical outcome of scoliosis
correction in Duchenne muscular
dystrophy using different instrumentation
constructs
(SP5) RAPPER II - Robot Assisted
PhysiotheraPy Exercises WITH REX powered
walking aid in patients with spinal cord
injury
Hossein Mehdian (Queens Medical Centre,
Nottingham University Hospitals NHS Trust)
Nick Birch (Chris Moody Rehabilitation
Centre, Northants)
12.20-12.30
11.55-12.00
(30) Major complications of primary
versus revision surgery in patients
undergoing corrective surgery for adult
spinal deformity using three column spinal
osteotomies
(SP6) Long term outcome of paediatric
spinal cord injury
Naveen Kumar (Robert Jones and Agnes
Hunt Orthopaedic Hospital, Oswestry)
Silviu Sabou (Queens Medical Centre,
Nottingham University Hospitals NHS Trust)
12.00-12.05
(SP7) C2 odontoid process fractures in the
elderly: observations on the natural history
of non-operative management
Andreas Demetriades (Western General
Hospital, Edinburgh)
12.05-12.10
(SP8) Occipital condyle fractures – the
need for immobilisation?
Syed Aftab (Barts Health NHS Trust)
12.10-12.15
(SP9) Comparison of EVICEL® and Tisseel
use for dural repair in spinal surgery
Myron Ciapryna (Royal National
Orthopaedic Hospital)
BRITSPINE 2016
40
Programme
12.15-12.20
(SP10) Surgery for spinal metastases is cost
effective: calculation of cost per QALY in UK
patients
Isobel Turner (National Hospital for
Neurology and Neurosurgery)
12.20-12.25
(SP11) Coccygodynia – transsacrococcygeal
ganglion impar block
Balaji Purushothaman (City Hospitals
Sunderland NHS Foundation Trust)
12.25-12.30
(SP12) Spinal meningiomata: what lessons
can be learned after long term (>10 years)
follow up
Andreas Demetriades (Western General
Hospital, Edinburgh)
12.30-13.00
INTERACTIVE
DISCUSSION
Towards Guidelines in Adult Spine
Deformity Surgery
Reports from UKSSB Society for Back
Pain Research (SBPR) Travelling Fellows
Speakers
Sashin Ahuja/Bob Crawford/Joost van
Middendorp (The Netherlands)
(1) A European collaboration on a project
for antibiotics for LBP
Dr Majid Artus (Keele University)
(2) Assisting ‘significant others’ in the
collaborative self-management of pain
Dr Serena Bartys
(University of Huddersfield)
(3) An investigation into roles of Spinal
Extended Scope Physiotherapy
Practitioners (ESP) within the Acute
NHS setting
Jill Billington (Lancashire Teaching
Hospitals NHS Trust)
(4) Normal biomechanics of the lumbar
spine: a quantitative fluoroscopy and
electromyography study
Alister du Rose
(Institute for Musculoskeletal Research
and Clinical Implementation)
(5) Investigating variation in lumbar spine
curvature in asymptomatic individuals
with modic changes and lumbar disc
degeneration
Anastasia Pavlova
(University of Aberdeen)
(6) Visit to Insight Centre for Data
Analytics: Collaboration towards the
development of wearable technologies
for classification and personalised
therapies for back pain
Dr Liba Sheeran (Cardiff University)
(7) The science of spinal pain: the way
forward for improved management for
people with back pain
Dr Valerie Sparkes (Cardiff University)
13.00-14.00
41
LUNCH & EXHIBITION
BRITSPINE 2016
Programme
WORKSHOPS & AOSPINE SESSION
14.00-15.00
15.00-16.10
PERSPECTIVES ON CURRENT HEALTHCARE DEVELOPMENTS IN ENGLAND (UK)
Chairs
Alistair Stirling/Nick Birch
14.00-14.05
Introduction Alistair Stirling
14.05-14.25
Perspectives on current healthcare developments in England Allyson Pollock
14.25-14.45
Perspectives on current healthcare developments in England Sir Bruce Keogh
14.45-15.00
Floor questions
BEST OF SHOW PAPERS
Chairs
Phil Sell/John Dormans
15.00-15.10
(31) Interspinous process fixation versus pedicle screw fixation in circumferential
arthrodesis: 1-year outcomes from a prospective randomised multi-center trial
Ryan Denhaese (AXIS Neurosurgery and Spine, New York, USA)
15.10-15.20
(32) How “up to date” should pre-operative scans be?
Hean Wu Kang (Royal Victoria Hospital, Belfast)
15.20-15.30
(33) Therapeutic efficacy of particulate vs non-particulate steroids for cervical and
lumbar radiculopathy
Nanjundappa Harshavardhana (Twin Cities Spine Center, Minneapolis, USA)
15.30-15.40
(34) The development and validation of a 3D ultrasound system for monitoring curve
progression of patients with scoliosis
Eskinder Solomon (Guy’s and St Thomas NHS Foundation Trust)
15.40-15.50
(35) Do surgeons need to rescrub during operations that last longer than three hours?
Pooria Hosseini (San Diego Spine Foundation, California, USA)
15.50-16.00
(36) Social drift - a comparative analysis of balloon kyphoplasty for osteoporotic
vertebral compression fractures and surgery for fractured neck of femur
Edmund Charles (Royal Derby Hospital)
16.00-16.10
(37) Are we ready for transfusing intraoperative salvaged blood in metastatic spine
tumour surgery
Naresh Kumar (National University Health System, Singapore)
BRITSPINE 2016
42
Programme
16.10-16.40
ADDRESS
How Specialist Associations Support Spinal Surgeons
16.10-16.20
Society of British Neurological Surgeons (SBNS) – Rick Nelson (SBNS Past President)
16.20-16.30
British Orthopaedic Association (BOA) – Colin Howie (BOA Past President)
16.30-16.40
Questions
16.40-17.25
UKSSB GENERAL MEETING
17.30-18.45
BASS ANNUAL GENERAL MEETING
19.30
Coaches depart from Nottingham Conference Centre to Colwick Hall
20.00
CONFERENCE DINNER – COLWICK HALL
23.30-01.00
Coaches return from Colwick Hall to the Nottingham Conference Centre
43
BRITSPINE 2016
Programme
Friday 8 April 2016 - Nottingham Conference Centre
LECTURE THEATRE 2
08.00-09.00
REGISTRATION
NOTTINGHAM CONFERENCE CENTRE
09.00-10.00
PAPERS
British Association of Spine Surgeons
(BASS) and British Scoliosis Society (BSS)
LECTURE THEATRE 4
Society for Back Pain Research (SBPR)
(Infection/Tumour)
Chairs
09.00-09.10
09.10-09.20
Shanmuganathan Rajasekaran/
Adrian Casey
Steven Vogel/Elaine Buchanan
(38) Gentamicin fleece and the incidence
of surgical site infections following spinal
deformity surgery for adolescent idiopathic
scoliosis
(44) Lumbar spine CT-based fractal analysis
may help in detecting decreased quality
of bone prior to urgent spinal procedures
(novel technique)
Muhammad Adeel Akhtar (James Cook
University Hospital)
Marcin Czyz (Queens Medical Centre,
Nottingham University Hospitals NHS Trust)
(39) Single stage anterior corpectomy and
posterior instrumentation in tuberculous
spondylitis with varying degrees of
neurological deficit
(45) Lumbar stability following graded uniand bilateral graded facetectomy - a finite
element model study
Ujjwal Debnath (Ramakrishna Mission,
Kolkata, India)
09.20-09.30
09.30-09.40
Abdul Gaffar Dudhniwala (University Hospital
of Wales)
(40) Should spinal MRI scans be used to
determine the duration of therapy for
spinal tuberculosis?
(46) Is there a correlation between MRI
fat depths and BMI measurements in the
lumbar spine?
Emily McGhee (Guy’s and St Thomas’ NHS
Foundation Trust)
Simon Hughes (Salford Royal Foundation Trust)
(41) A cost-utility analysis of surgical
intervention in metastatic spinal cord
compression (MSCC)
(47) The influence of BMI and age on the
outcomes of minimally invasive lumbar
interbody fusion in the surgical treatment
of lumbar degenerative disorders – a multicentre subgroup analysis study
Bilal Chaudhry (Salford Royal Foundation
Trust)
Khai Lam (Guy’s and St Thomas’ NHS
Foundation Trust)
09.40-09.50
(42) Outcomes of revision surgery for spinal (48) Do outcomes vary following minimally
metastatic disease
invasive lumbar fusion in patients with
Zak Choudhury (Royal Orthopaedic Hospital, spinal stenosis? A multi-centre subgroup
analysis study
Birmingham)
Khai Lam (Guy’s and St Thomas’ NHS
Foundation Trust)
09.50-10.00
(43) Outcome and health related quality of
life after surgery for spinal metastases
Nasir Quraishi (Queens Medical Centre,
Nottingham University Hospitals NHS Trust)
10.00-10.30
10.30-11.00
BRITSPINE 2016
KEYNOTE
LECTURE
What is New in Spinal Infections?
Shanmuganathan Rajasekaran (India)
Introduction
Nasir Quraishi
(49) A cost utility comparison of
transforaminal endoscopic discectomy and
microdiscectomy
Chloe Scott (Royal Infirmary and University of
Edinburgh)
COFFEE & EXHIBITION
44
Programme
11.00-12.00
PAPERS
British Association of Spine Surgeons
(BASS) and British Scoliosis Society (BSS)
SPECIAL POSTERS
(Trauma/Tumour)
Chairs
Bronek Boszczyk; El-Nasri Ahmed
Zdenek Klezl; Magnum Tsegaye
11.00-11.10
11.00-11.05
(50) Comparison of segmental pedicle
screws versus hybrid constructs using
sublaminar wires for deformity correction
in cerebral palsy
(SP13) Interbody fusion in low grade
spondylolisthesis – clinical outcome do not
correlate with slip reduction and neural
foraminal dimension
Luigi Nasto (Queens Medical Centre,
Nottingham University Hospitals NHS Trust)
Ujjwal Debnath (Ramakrishna Mission,
Kolkata, India)
11.10-11.20
11.05-11.10
(51) Posterior instrumented fusion
for thoracolumbar kyphosis in
mucopolysaccharidoses type 1
(SP14) Feasibility of manufacturing a
patient specific spinal implant
Thomas Finnigan (Royal Manchester
Children’s Hospital)
Tiziano Serra (University College London/
Royal National Orthopaedic Hospital)
11.20-11.30
11.10-11.15
(52) Effects of frequency of distraction
in magnetically-controlled growing
rod lengthening on outcomes and
complications
(SP15) Clinico-radiological outcomes
following transforaminal versus lateral
lumbar interbody fusion
Chrishan Thakar (San Diego Center for
Spinal Disorders, California, USA)
Fady Sedra (Royal National Orthopaedic
Hospital)
11.30-11.40
11.15-11.20
(53) Computational models for
characterisation and design of patientspecific spinal implant
(SP16) The 3 year effects of a four-week
intensive scoliosis-specific physiotherapy
(SSP) programme on patient-reported
quality of life (QoL) in adults with
idiopathic scoliosis (IS)
Claudio Capelli (University College London)
Michael Bradley (Scoliosis SOS, London)
11.40-11.50
11.20-11.25
(54) Metastatic spine tumour surgery:
minimally invasive approach versus open
approach
(SP17) Improvement in unfused adjacent
segment disc condition following posterior
spine fusion for adolescent idiopathic
scoliosis
Naresh Kumar (National University Health
System, Singapore)
Wai Weng Yoon (Queen’s Medical Centre,
Nottingham/Women and Children’s Hospital,
Adelaide, Australia)
11.50-12.00
11.25-11.30
(55) Rib-sparing minimally invasive
vertebrectomy is a safe and effective
treatment for single-level metastatic spinal
disease; a case series of 15 patients
(SP18) Sagittal alignment of the
cervical spine following correction of
Scheuermann’s kyphosis
Edward Rice (Leeds General Infirmary)
Luigi Nasto (Queens Medical Centre,
Nottingham University Hospitals NHS Trust)
11.30-11.35
(SP19) Reduction of high grade
spondylolisthesis through a posterior
approach and restoration of the pelvic
parameters
Shrijit Panikkar (Salford Royal NHS
Foundation Trust)
45
BRITSPINE 2016
Programme
11.35-11.40
(SP20) Perioperative complications of
pedicle subtraction osteotomy
Sujay Dheerendra (Royal Liverpool University
Hospital)
11.40-11.45
(SP21) Predictive factors for APJF after adult
deformity surgery: a multivariate analysis
Prokopis Annis (Royal Liverpool University
Hospital)
11.45-11.50
(SP22) The fate of l5-S1 with low dose BMP-2
and pelvic fixation in adult deformity surgery
Prokopis Annis (Royal Liverpool University
Hospital)
11.50-11.55
(SP23) Medium term outcome of
posterior surgery in the treatment of nontuberculous bacterial spinal infection
Elmajee Mohammed (Salford Royal NHS
Foundation Trust)
11.55-12.00
(SP24) Management of postoperative spine
wound infections using vacuum assisted
closure (VAC) therapy
Robert Lee (Royal National Orthopaedic
Hospital/Vancouver General Hospital, Canada)
12.00-12.45
INSTRUCTIONAL
SESSION
Chair
12.00-12.02
Paul Davies
Introduction
Paul Davies
12.02-12.08
The development and natural history of PARS lesions in professional cricket
Nick Peirce (Chief Medical Officer - England & Wales Cricket Board)
12.08-12.14
Conservative treatment in “young” patients with symptomatic spondylolysis and a
normal disc (on MRI scan)
Robin Chakraverty (Chief Medical Officer - British Athletics)
12.14-12.20
If conservative treatment fails the surgical treatment consists of direct pars repair
Lester Wilson
12.20-12.26
Uninstrumented fusion in failed conservative treatment in low grade spondylolytic
spondylolisthesis with a normal disc
Thanos Tsirikos
12.26-12.32
When do I consider 360 degree fusion in a spondylolytic spondylolisthesis?
Daniel Chan
12.32-12.45
Questions from the floor/summary
Paul Davies
12.45-13.00
PRIZES
13.00-13.30
LUNCH
13.30-17.00
AFTERNOON
SESSIONS
BRITSPINE 2016
Management of Symptomatic Spondylolysis
“If it’s broke, if and when to fix it?”
Presentations by Nasir Quraishi
Together:
Together:
Optimising collaborative working for
spinal conditions
Implementation of the National Low
Back and Radicular Pain Pathway and
related matters
46
Programme
BRITSPINE 2016 NOTTINGHAM
Together:
Optimising Collaborative Working for Spinal Conditions
Friday 8 April 2016 - Nottingham Conference Centre
13.00
REGISTRATION (BritSpine Registration Desk)
ADAMS ROOM, 2ND FLOOR
Time
Topic
Moderator
14.00-14.05
Introduction
Jeremy Fairbank
14.05-14.10
Symposium on spinal cord stimulation for chronic spinal pain
Nick Birch
14.10-14.20
Overview of global burden of pain, indications for spinal cord
stimulation and literature review and scope of RCT
Nick Birch
Spinal cord stimulation – the technology
Nick Birch
14.20-14.30
Paula Wray
Paula Wray
14.30-14.40
Spinal cord stimulation – application in the real world
Nick Birch
Paula Wray
14.40-15.00
Round table Q&A
Paula Wray
Jane Stewart
Speaker
Prof Jeremy
Fairbank
Prof Sam Eldabe
Prof Adnan El-Kaisy
Prof Jeremy
Fairbank
Prof Sam Eldabe
Prof Adnan El-Kaisy
15.00-15.05
Charity forum
David Chapple
15.05-15.30
Horatio’s Garden
David Chapple
15.30-15.45
Tea
15.45-16.15
Olivia Chapple
Nick Todd
Symposium on Guidelines for the Management of Cauda
Equina Syndrome
David Chapple
Q&A Guidelines for the Management of CES
David Chapple
Am Rai
Paula Muter
16.15-16.30
Nick Todd
Am Rai
Paula Muter
16.30-16.55
16.55-17.00
47
Spinal cord injury priority setting partnership
Jeremy Fairbank
Summary and close
Nick Birch
Joost van
Middendorp
BRITSPINE 2016
Programme
BRITSPINE 2016 NOTTINGHAM
Together:
Improving Spinal Care Project
National Low Back and Radicular Pain Pathway
Friday 8 April 2016 - Nottingham Conference Centre
13.00
REGISTRATION (BritSpine Registration Desk)
BOWDEN ROOM, 2ND FLOOR
Time
Topic
Chair
Speaker
Welcome and purpose
Alistair Stirling
Alistair Stirling
13.30-13.35
David
Waddingham
13.35-13.40
Why this matters
Anthony Zalin
13.40-13.50
Pathfinder project – overview
Charles Greenough
13.50-14.00
In practice – north east progress to date
Andrea Jones
14.00-14.10
Project management and franchise
Helen Ridley
14.10-14.20
Discussion
14.20-14.30
AHP perspective – triage and manage practitioners
Tim Pigott
Diarmaid Ferguson
Lisa Roberts
14.30-14.40
Primary care and commissioning perspective
Andrea Jones
14.40-14.50
Secondary care perspective
David Cumming
14.50-15.00
Discussion
15.00-16.00
Workshops
1) How to implement Pathfinder - discussions
David Cumming
Charles Greenough
2) Training of triage and manage practitioners
Diarmaid Ferguson
Steve Vogel
3) Federation of spinal care professionals, communication
and governance
Elaine Buchanan
Tim Pigott
4) Commissioning aspects
Andrea Jones
David
Waddingham
5) Data and assessment of outcomes
Lisa Roberts
Ashley Cole
Mike Hutton
6) Annual spinal care implementation meeting
Alistair Stirling
Sarah Kirkland
16.00-16.15
Tea
16.15-16.45
Reprise - 5 minute summary from each workshop
16.45-17.00
Summary panel and future action
17.00
BRITSPINE 2016
Tim Pigott
Elaine Buchanan
Alistair Stirling
David
Waddingham
Charles Greenough
Close
48
Wednesday,2nd
6th April
Wednesday,
April
Podium Presentations
British Association of Spine Surgeons (BASS)
(1) 09.00-09.10
Use of antibiotic and incidence of antibiotic
associated diarrhoea in patients with spinal
cord injuries: a UK National Spinal Injury Centre
experience
Main Author: Samford Wong
Co Authors: Piera Santullo, Mofid Saif
Affiliation: National Spinal Injuries Centre, Stoke Mandeville
Hospital, Aylesbury HP21 8AL
Conflicts of Interest: None declared
Funding Sources: None declared
Background Context: The frequency of antibiotic associated
diarrhoea (AAD) could be as high as 60% during hospital
outbreaks or intermediate (13-29%) during endemic periods1.
Little is known about the use of antibiotics and the extent of
AAD in patients with spinal cord injuries (SCI).
Purpose: Our aim was to (1) record the use of antibiotics; (2)
establish the incidence of AAD and; (3) assess if any seasonal
variation on antibiotic use and incidence of AAD.
Study Design/Setting: Single centre study
Patient Sample: Three-hundred-and-nineteen adults (mean
age: 55.9 years, 29.2% female) with SCI (58.2% tetraplegia;
43.7% complete SCI) were included.
Outcome Measures: We define AAD as 2 or more watery
stools type 5, 6 or 7 (Bristol stool scale) over 24 hours.
Methods: A retrospective audit was conducted in a UK SCI
centre during October 2014 to June 2015. Data was collected
by trained researcher from individual patient notes using a
standardised questionnaire.
Results: Three-hundred-and-nineteen adults (mean age:
55.9 years, 29.2% female) with SCI (58.2% tetraplegia; 43.7%
complete SCI) were included. Of 76 (23.8%) patients on
antibiotics, the top three indications for antibiotics were
urinary-tract infections, pressure ulcers and skin-infection.
Seventeen of 76 (22.3%) developed AAD. No statistical
difference was observed on number of antibiotics, severity
of SCI, use of proton-pump inhibitor and H2 blocker and use
of laxatives in both groups. AAD was more common in the
summer season when compared to spring, autumn and winter.
(44.4%, 10.5%, 9.1%, 29.4%, p=0.02). AAD was associated with
older adult greater than 65 years (64.7% v 33.3%, p=0.042)
Conclusions: This survey found AAD is common in SCI
patients and maybe a risk factor for poorer outcome and
increased hospital cost. A multicenter study is underway to
establish the incidence and risk factors for AAD.
(2) 09.10-09.20
Management of deep spinal infections in a tertiary
centre
Main Author: Navin Furtado
Co Authors: Ravi Vemaraju, Angelo Pichierri
Affiliation: University of Birmingham Medical School &
University Hospitals Birmingham
NHS Foundation Trust
49
Conflicts of Interest: None
Funding Sources: None
Background Context: De novo deep spinal infection
is rare but can potentially lead to serious consequences
for the patient if not identified and treated promptly and
appropriately. Early clinical diagnosis would be desirable but
it is often delayed and responsible organisms can be difficult
to isolate if broad-spectrum antibiotic treatment has been
initiated prior to microbiological diagnosis.
Purpose: To review the management of de novo deep
spinal infections in a regional tertiary specialist unit and to
investigate the current diagnostic strategies for spontaneous
spinal infection with the aim of producing a modified
management algorithm for future implementation.
Study Design/Setting: Retrospective
Patient Sample:: 83 patients
Outcome Measures: Microbiology diagnosis, treatment
duration and surgical intervention
Methods: All patients referred to a regional tertiary specialist
spinal unit with a radiological diagnosis of de novo deep
spinal infection over a 12 months period (2013 to 2014) were
reviewed and data including demographics, clinical features,
investigations, microbiology, treatment and patient outcomes
were collated. The data from our series was analysed and
compared to best practice management as described in peerreviewed journals.
Results:: From the overall patient cohort, 42% of patients
were managed directly within the tertiary spinal unit. For
those patients that underwent surgery, a microbiological
diagnosis was not obtained in 44% of cases. Overall,
organisms could only be identified in 33% of cases. A positive
yield from a CT guided biopsy was 11%. More than 70% of
patients had a good recovery with improved neurological
status and function.
Conclusions: The majority of patients were managed
non-operatively with evidence from flow-up of good clinical
improvement following treatment. We suggest the use of
a modified algorithm to be used for the management of de
novo deep spinal infections.
(3) 09.20-09.30
Spontaneous epidural infections: a prospective patient
reported review at a single tertiary centre
Main Author: Saffwan Mohamed
Co Authors: Nisaharan Srikandarajah, Nadia Al-Najjar, Ruth
Stott, Tim Pigott
Affiliation: The Walton Centre NHS Foundation Trust, Lower
Lane, Liverpool L9 7TJ
Conflicts of Interest: No conflicts of interest.
Funding Sources: No funding obtained.
Background Context: Spontaneous epidural Infection
(SEI) is an increasingly prevalent condition with potentially
severe consequences.
Purpose: To review surgical management of patients with
SEI and their outcome.
Study Design/Setting: A retrospective case notes review
with prospectively collected COMI scores.
Patient Sample: Prospectively collected patients using the
Spine Tango system.
BRITSPINE 2016
Wednesday, 6th April
Outcome Measures: Core Outcome Measures Index (COMI)
Methods: Case notes review was conducted for all adult
patients admitted to a tertiary neurosurgical centre
between January 2012 and August 2015. Inclusion criteria
included diagnosis of SEI based on radiographic studies
and/or operative findings. Exclusion criteria included
previous spinal surgery.
Results: There were 47 patients; 30 male, 17 female.
Average age at operation was 55 (range 22 to 77). The
mean hospital stay was 29 days. In this cohort, 19.1 % had
cervical, 27.7% thoracic, 53.2% lumbo-sacral involvement
spanning 2.4 vertebral segments on average. MethicillinSensitive Staphylococcus Aureus (MSSA) was the most
common isolated pathogen (53.2%) then E.coli (8.5%).
COMI scores were taken at 3 months. The mean Back-COMI
score was 6.31 points (0.7 to 10, n=20). The mean NeckCOMI score was 3.88 points (1 to 6, n=3). In comparison, the
ACDF (brachialgia) COMI for 507 patients at 3 months was
5.15. The mean cost to the trust per patient was obtained at
an average of £18,060 (n=38).
Conclusions: Although a rare condition, SEI results in
protracted in-patient stay with substantial overall cost to
the trust. Back-COMI scores for SEI were higher compared
to ACDF-COMI scores at 3 months. This suggests that
management of SEI can be optimised to maximise patient
outcomes and reduce in-patient stay.
(4) 09.30-09.40
The safety, efficacy and cost-effectiveness of
intraoperative cell-salvage in metastatic spine
tumour surgery
Main Author: Mahmoud Elmalky
Co Authors: Naveed Yasin, Ricardo Pinto, John Stephenson,
Craig Carroll, Glyn Smurthwaite, Rajat Verma, Saeed
Mohammad, Irfan Siddique
Affiliation: Salford Complex Spine Unit, Salford Royal NHS
Foundation Trust, Stott Lane, Salford M6 8HD
Conflicts of Interest: No conflicts of interest to report
Funding Sources: No funding obtained
Background Context: This is the first comparative study
in the literature evaluating efficacy, safety and cost
effectiveness of using intraoperative cell salvage with
leucocyte depletion filter (IOCS-LDF) in metastatic spine
tumour surgery (MSTS).
Purpose: To evaluate safety, efficacy and cost effectiveness
of IOCS-LDF in MSTS
Study Design/Setting: Retrospective comparative study
Patient Sample: All patients undergoing MSTS at a single
centre from February 2010 till December 2014 (n=176)
Outcome Measures: Primary outcome measure was
the use of autologous blood transfusion. Secondary
outcome measures included hospital stay, survival time,
complications and procedural costs. The key predictor
variable was whether or not IOCS-LDF was utilised during
surgery.
Methods: Logistic and linear regression analyses were
conducted using controlling variables; tumour type,
number of diseased vertebrae, approach, number & site
of stabilised segments, operation time, pre-operative
anaemia, ASA grade, age, gender and BMI.
BRITSPINE 2016
Results: Data included 63 cases (IOCS-LDF) and 113
controls (non IOCS-LDF). IOCS-LDF utilisation was
substantively and significantly associated with a lower
likelihood of autologous blood transfusion (OR 0.407,
p=0.03). Use of IOCS-LDF was cost neutral (p=0.88).
Average hospital stay was 3.76 days shorter amongst IOCSLDF patients (p=0.03). Patient survival and complication
rates were comparable in both groups.
Conclusions: We have demonstrated that use of IOCS-LDF
is appears to be safe, cost effective and associated with a
lower need for allogenic blood transfusion in MSTS.
(5) 09.40-09.50
Flowcytometric evaluation of intraoperative
salvaged blood filtered with leucocyte depletion
filter in metastatic spine tumour surgery
Main Author: Naresh Kumar1
Co Authors: Aye Sandar Zaw1, Raymond Lam1, Aravind
Kumar2
Affiliation: 1.Department of Orthopaedic Surgery, National
University Health System, Singapore, 2.Department of
Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore
Conflicts of Interest: None
Funding Sources: None
Background Context: Intra-operative cell salvage (IOCS)
has not been widely adopted in oncological surgery due to
hypothetical concerns of reinfusing malignant cells.
Purpose: To evaluate the feasibility of IOCS in combination
with leucocyte depletion filter (LDF) in metastatic spine
tumour surgery (MSTS) using quantitative flowcytometry
technique
Study Design/Setting: Prospective observational
Patient Sample: Eleven patients operated for metastatic
spinal disease were recruited.
Outcome Measures: Tumour cells count
Methods: Blood samples (5mls each) were collected at
five different stages during surgery: stage A and B: from
patients’ vein during induction and at the time of maximum
tumour manipulation; stage C, D and E: from the operative
blood prior to IOCS processing, after IOCS processing and
after IOCS-LDF processing. All samples were analyzed using
flowcytometry technique.
Results: Flow cytometry analysis showed that 8/11 patients
had tumour cells in unfiltered salvaged blood. In filtered
salvaged blood, the tumour cell count was zero in 8 patients’
samples while 3 patients’ samples had a few tumour cells.
The difference in mean tumour cell quantity between
the samples from stage A and E was significant (P=0.04).
Similarly, the difference between the samples in stage B and
E was significant (P=0.01). However, there were no significant
differences when comparing the samples from either stage
A and B, D and E or C and E.
Conclusions: IOCS-LDF was shown to be effective in
removing tumour cells from blood salvaged during MSTS.
The quantity of tumour cells, if any, was significantly less
than that in patient’s circulation. The results of this study
imply that IOCS-LDF treated blood is safe for re-transfusion.
50
Wednesday, 6th April
(6) 09.50-10.00
Evaluation of the safety of using intraoperative
salvaged blood in metastatic spine tumour surgery:
using Microwell technique
Main Author: Naresh Kumar1
Co Authors: Aye Sandar Zaw1, Bee Luan Khoo2, Jean Paul
Thiery2, Aravind Kumar3
Affiliation: 1.Department of Orthopaedic Surgery,
National University Health System, Singapore, 2.Institute
of Molecular and Cellular Biology, National University of
Singapore, 3.Department of Orthopaedic Surgery, Khoo
Teck Puat Hospital, Singapore
Conflicts of Interest: None
Funding Sources: None
Background Context: Intra-operative cell salvage (IOCS) is
not widely used in oncological surgery due to hypothetical
concern of reinfusion of tumour cells.
Purpose: To evaluate our hypothesis that tumour cells,
which pass through the cell saver system lose viability.
Study Design/Setting: Prospective observational
Patient Sample: Thirteen patients who underwent
metastatic spine tumour surgery (MSTS)
Outcome Measures: Tumour cells viability
Methods: Blood samples (5 ml each) were collected at five
different stages during surgery: A: venous blood from the
patient during induction; B: venous blood during maximum
tumour manipulation; C: blood from the operative field
prior to cell saver processing; D: salvaged blood processed
by the cell saver prior to LDF filtration; and E: salvaged
blood after being processed with both IOCS and leucocyte
depletion filter (LDF). The samples were then analyzed for
the viability of tumour cells using Microwell based culture.
Results: Haemonectics cell saver was used in 11 patients
and Dideco cell saver in 2 patients. Analysis of the cultured
samples showed that clusters or cytokerain positive CTCs
(CK+ CTCs) were found in the samples taken from stage A
in 3 patients, B in 3 patients and C in 1 patient. However,
none of the samples D and E from any patients generated
tumour cell clusters or CK+ CTCs after culture.
Conclusions: The salvaged blood using the standard cell
saver machine may retain some tumour cells but they are
damaged and hence unable to replicate and metastasize.
The results of this study imply that IOCS processed blood in
MSTS is safe for transfusion.
Podium Presentations
Affiliation: Spine Unit, Oxford University Hospitals
Foundation NHS Trust, Headley Way, Headington, Oxford
Conflicts of Interest: L Rehák – DePuy Synthes Spine (a),
Kspine (a); M Repko – Kspine (a); M Grevitt – DePuy Synthes
Spine (a,b), Medtronic (a); U Aydinli – Kspine (a); A Carl –
K2M (e), Kspine (b,e,g); C Nnadi – No conflicts; B Akbarnia
– Alphatec (c), DePuy Synthes Spine (a,g), Ellipse Technology
(b,g), K2M (b,g), Kspine (b,e,g), Nuvasive (a,b,c,g); D Crandall
–Ellipse Technology (b), Kspine (b,e,g), Medtronic (b,g),
Spinewave (b), Stryker (b,d), Zyga (b)
(a) Grants/Research Support (b) Consultant (c) Stock/
Shareholder (d) Speaker’s Bureau (e) Advisory Board or
Panel (f ) Salary, Contractual Services (g) Other Financial or
Material Support (royalties, patents, stock options, etc)
Funding Sources: K2M Sponsorship
Background Context: The consequence of a spinal fusion
is an abnormal load on adjacent levels with increased risk of
future adjacent segment degeneration.
Purpose: To evaluate the amount of motion present at
instrumented but unfused segments and at motion segments
adjacent to the instrumentation following application of a
new Posterior Apical Short-Segment correction technique
for correcting adolescent idiopathic scoliosis (AIS).
Study Design/Setting: Prospective observational multicenter study.
Patient Sample: 21 female patients
Outcome Measures: Radiographic data were collected
pre-operatively, at surgery, and at 3, 6 and 12 months after
surgery.
Methods: The new system applied translational and
derotational forces over a short apical segment. The short
apical region was fused while maintaining motion of
unfused vertebral segments.
Results: 21 female patients, mean age of 14.2 years (10.616.9 years) with Lenke 1A/1B curves were enrolled.
Range of motion in the non-fused instrumented segment
was significantly higher than the apical fused segment (11
vs. 0.9, p <0.001). Range of motion of non-fused vertebral
levels distal to the construct at one year did not differ
significantly from their respective pre-op values.
The analysis was extended to understand the impact of
lower instrumented vertebra (LIV) on motion of non-fused
segments distal to the construct: 1) the change in motion
from pre-op to 12 months post-op as a function of LIV is
not statistically significant; 2) The motion of the non-fused
distal vertebral segments at 12 months does not statistically
increase with a lower LIV.
Conclusions: Through one year, this novel technique
maintained the mobility of non-fused motion segments.
British Scoliosis Society (BSS)
(8) 09.10-09.20
(7) 09.00-09.10
Analysis of segmental mobility following a novel
posterior apical short-segment correction for
adolescent idiopathic scoliosis
Main Author: Colin Nnadi
Co Authors: Colin Nnadi, Pooria Hosseini, Ľuboš Rehák,
Martin Repko, Michael Grevitt, Ufuk Aydinli, Allen Carl,
Jeff Pawelek, Dennis Crandall, Behrooz A Akbarnia, Pavlos
Panteliadis, Chrishan Thakar
51
Clinical and radiologic outcome from 360-degree
lumbar spondylodesis using porous tantalum cages
in spinal reconstruction for degenerative lumbar
spine deformity
Main Author: Karan Malhotra
Co Authors: Joseph S Butler, Darren F Lui, Haiming Yu,
Maria L Suarez-Heurta, Susanne Selvadurai, Obikezi Agu,
Sean Molloy
BRITSPINE 2016
Wednesday, 6th April
Affiliation: Royal National Orthopaedic Hospital, Stanmore,
Brockley Hill, HA7 4LP
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: We routinely perform posterolateral
instrumented spondylodesis and anterior lumbar
interbody fusion (ALIF) in complex spinal reconstruction
for degenerative lumbar spine deformity using the
Zimmer®TM-400 tantalum implant.
Purpose: To assess implant performance, fusion, and
clinical and radiologic outcomes of porous tantalum cages
for ALIF in a 360-degree spondylodesis.
Study Design/Setting: Retrospective cohort study.
Patient Sample: 333 patients underwent ALIF and
posterolateral spondylodesis using 880 porous tantalum
cages over a 4-year period.
Outcome Measures: We compared preoperative and
postoperative radiographic parameters and health related
quality of life (HRQOL) scores: Oswestry disability index
(ODI) and EQ-5D.
Methods: We analysed surgical data, complications and
need for revision. Radiographic follow-up was performed
to document any implant related problems. HRQOL scores
were recorded preoperatively and at 6 weeks, 6 months, 1
year and 2 years postoperatively.
Results: No neurological, vascular or visceral injuries were
reported. There were no rod breakages or symptomatic
non-unions at tantalum cage levels. One revision procedure
was performed for fracture. Postoperatively mean lumbar
lordosis increased from 43°±18° to 53°±12° (p<0.001). At
2 years VAS score had improved from 7.5±2.38 to 3.0±2.9
(p=0.02), ODI improved from 58.1±17.1 to 20.0±7.8
(p=0.002), and EQ-5D improved from 0.3±0.2 to 0.8±0.1
(p=0.03), compared to preoperative scores.
Conclusions: Porous tantalum cages have high strength
and flexibility, in addition to having similar biomaterial
properties to cancellous bone. Their use in 360-degree
spondylodesis to treat degenerative lumbar spine deformity
has been demonstrated to be very safe and effective, with
excellent clinical and functional outcomes.
(9) 09.20-09.30
Health related quality of life in patients undergoing
cervico-thoracic osteotomies for fixed cervicothoracic kyphosis in patients with ankylosing
spondylitis
Main Author: Silviu Sabou
Co Authors: Dritan Pasku, Nasir A Quraishi, Hossain
Mehdian
Affiliation: Centre for Spinal Studies and Surgery, Queens
Medical Centre Campus of Nottingham University Hospitals
NHS Trust, Derby Road, Nottingham NG7 2UH
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Ankylosing spondylitis (AS) can
result in severe cervico-thoracic kyphotic deformity (CTKD).
Few studies have addressed the relationship between
cervical osteotomy and health-related quality of life scores
(HRQOL).
BRITSPINE 2016
Purpose: The aim of this study is to evaluate the impact of
C7-T1 osteotomy on improving quality of life for patients
with fixed CTKD.
Study Design/Setting: Retrospective analysis of
prospectively collected data.
Patient Sample: 13 male patients were included.
Outcome Measures: Neck Disability Index (NDI), EuroQol
5D-5L (EQ-5D-5L) and EuroQol Visual Analogue Scale (EQVAS)
Methods: Quality of life data were collected prospectively
on HRQOL measures. Patient’s radiological outcomes were
assessed on whole spine standing X-rays by measuring
chin-brow to vertical angle (CBVA), C7-Slope, C2-7 angle,
Regional Kyphosis Angle (RKA), C2-C7 sagittal vertical axis
(SVA), C7-S1 SVA.
Results: The mean age was 57.5 years (40-74); mean
follow up was 37.6 months (12-78). Pre-operative CBVA
was on average 54° (40°-75°) and postoperative was 7°
(2°-12°). Following the C7-T1 osteotomy (10 Smith Peterson
Osteotomies and 3 Pedicle Subtraction Osteotomies), NDI
improved from a mean 65.54 (SD 8.95) to a mean of 22.09
(SD 6.99). The EQ-5D-5L improved from a mean of 0.41(SD
0.16) to 0.86 (SD 0.088). There were no major complications,
1 superficial infection and 5 minor nerve root irritations.
Conclusions: Cervical osteotomy for the management
of fixed flexion deformity of cervical spine in ankylosing
spondylitis is a safe procedure and can result in restoration
of horizontal gaze and sagittal balance with significant
improvement of the patient’s health related quality of life.
(10) 09.30-09.40
Pre- and post-operative 3D gait analysis in highgrade spondylolisthesis
Main Author: Sudarshan Munigangaiah
Co Authors: Gill Holmes, Collin Bruce, Jayesh Trivedi, Neil
Davidson
Affiliation: Department of Spine Surgery, Alder Hey
Children’s NHS Foundation Trust, Eaton Road, Liverpool L12
2AP
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Characteristic pelvic waddle gait has
been described in high-grade spondylolisthesis in the past.
To date, no study has been done to characterise change
in gait pattern pre and postoperatively in high-grade
spondylolisthesis using modern 3D gait analysis.
Purpose: 3D gait analysis in high-grade spondylolisthesis
pre and postoperatively to characterise gait pattern.
Study Design/Setting: Prospective interventional case
series.
Intervention: posterior decompression, posterolateral
instrumented fusion with reduction.
Patient Sample: High-grade spondylolisthesis
Outcome Measures: Physiologic measure: Gait deviation
index (GDI) score, Gait profile score (GPS)
Methods: Consecutive patients with high-grade
spondylolisthesis underwent pre and postoperative 3D gait
analysis studies.
Results: All 4 patients had Meyerding grade 4
52
Wednesday, 6th April
spondylolisthesis pre operatively. Mean age was 14.5
years and all were female. Pre and postoperatively mean
GDI score, right/left GPS were 76.35 and 91.72, 10.33/9.16
and 7.75/6.85 respectively. Surgery achieved reduction to
Meyerding grade 1 in all patients.
Common preoperative features in coronal plane included
pelvic obliquity and increased hip abduction. In sagittal
plane, posterior pelvic tilt, reduced flexion of hip at
initial contact, increased flexion of knee at initial contact,
decreased extension of knee in stance, decreased second
rocker in foot was noted. In transverse plane, increased
external rotation of hips and foot progression angle.
Postoperatively all sagittal parameters normalised.
Hip abduction, hip external rotation, and external foot
progression angle improved but did not return to normal.
Conclusions: In high-grade spondylolisthesis preoperative
gait abnormalities concern patients. Posterior
decompression, posterolateral instrumented fusion and
reduction normalised all sagittal gait parameters and
increased walking velocity, step and stride length.
(11) 09.40-09.50
Efficacy of SpineSage tool for assessing the
expected complication rates in adult spine
deformity surgery – preliminary results
Main Author: Marcin Czyz
Co Authors: Arion Kapinas, Ross Kenny, Nasir Quraishi,
Bronek M Boszczyk
Affiliation: Centre for Spinal Studies and Surgery; D
Floor, West Block; Queens Medical Centre; Derby Road;
Nottingham; NG7 2UH
Conflicts of Interest: Early results of the study were
presented at 3rd Annual Mount Sinai Spine Research Day and
Fellows Reunion on May 7th, 2015
Funding Sources: none
Background Context: The ‘SpineSage’ is an informatics
platform offering an objective and universal tool allowing
individualized estimation the perioperative complication
rate (CR) from spine surgery. It has never been validated
in predicting CR in cases of surgical correction of spinal
deformities.
Purpose: To assess the efficacy of SpineSage in predicting
probability of complications in adult spine deformity
surgery.
Study Design/Setting: Retrospective data analysis.
Patient Sample: Pilot group of 28 surgical cases of the adult
spine deformity.
Outcome Measures:
Methods: The necessary data (medical background,
details of the operation, perioperative complications) were
extracted from the patients’ medical records. Using the
online algorithm (http://spinesage.com) the predicted
complication rate (pCR) was estimated for each case. The
pCR was compared with the observed complication rate
(oCR) by mean of Fisher’s exact test.
Results: Three subgroups of patients were distinguished:
Group 1: pCR 0-30% - 8 cases; Group 2: pCR 31-70% - 12
cases and Group 3 pCR ≥71% - 8 cases. The oCR in particular
groups were as follows: Group 1 - 2 cases (25%); Group 2 -
53
6 cases (50%) and Group 3 – 6 cases (75%). There were no
significant differences between pCR and oCR ratios (Fisher
P=1.00 in all groups).
Conclusions: The initial results indicate the SpineSage
algorithm adjusted for the analysis of adult spinal deformities
may predict the real prevalence of complications. Our study
will be continued in a prospective setting in order to verify
that thesis basing on a wider group of patients.
(12) 09.50-10.00
Sacral osteotomies for correction of high pelvic
incidence
Main Author: Nasir A Quraishi
Co Authors: A Kapinas, D Pasku
Affiliation: Centre for Spinal Studies and Surgery, Queens
Medical Centre Campus of Nottingham University Hospitals
NHS Trust, West Block, D Floor, Derby Road, Nottingham NG7
2UH
Conflicts of Interest: Departmental research/fellowship
support Depuy Synthes, Medtronic
Funding Sources: Nil
Background Context: The limits of osteotomy are generally
reached when the degree of lumbar lordosis exceeds the
capabilities of the technique in cases of very high pelvic
incidence (PI >90 degrees). In these cases, the best place
for an osteotomy is between the sacral plateau and femoral
heads, in order to decrease the PI.
Purpose: Our aim was to analyse the outcome and alteration
in radiological parameters, including the change in PI, in
patients undergoing a sacral osteotomy.
Study Design/Setting: Retrospective review
Patient Sample: 3 patients’ case series with PI greater than
90 degrees
Outcome Measures: Radiological parameters, VAS, ODI
Methods: Review of radiological and clinical parameters
of cases after a sacral osteotomy performed by a single
surgeon.
Results: Three patients underwent sacral osteotomies to
reduce a very high PI. All patients were female with an average
age of 36 years (24-48) and a mean follow-up of 20 months
(10-36). The aetiology was high grade spondylolisthesis
with 2 patients having undergone previous fusion surgery.
Two patients underwent a S1 osteotomy and 1 had a S2
osteotomy (all 3 columns). The fixation was from L2/3/4pelvis in all patients with no complications.
The radiological parameters (mean) changed from preoperatively to final follow-up as follows: PI (103.5 to
75degrees), LL (44.5 to 52 degrees), SVA (17cm to 6.5cm).
Clinical markers (average) also improved: VAS LBP 8 to 3; VAS
LP 7 to 2; ODI 70 to 33.5.
Conclusions: In this small series of patients with very
distal lumbar/sacral kyphosis, a posterior sacral subtraction
osteotomy below the sacral plateau decreased the PI
achieving a better (but not perfect) sagittal profile.
BRITSPINE 2016
Wednesday, 6th April
10.00-10.30
KEYNOTE LECTURE
Genetic epidemiology of low back pain
Dr Frances M K Williams
(Consultant Rheumatologist)
However low back pain (LBP) is defined, it is considered to be a
common complex trait with both environmental and genetic
contributing factors. Twin and family studies show LBP to have
significant heritability of approximately 40%. This means that
genetic variants predisposing to LBP should be identifiable, but
convincing studies with replication in a different sample are few.
In this talk, the use of the twin model will be used to illustrate how we
can tease apart the genetic and environmental factors influencing
LBP. Twins which are identical (monozygotic, MZ) share 100% of their
genetic material while non-identical (dizygotic, DZ) twins share on
average 50%. Comparing the expression of a trait like LBP with and
between MZ and DZ twin pairs allows heritability to be estimated.
Furthermore, the degree of shared genetic overlap with other risk
factors, such as body mass index and bone mineral density, can
also be obtained. Finally twin pairs discordant for a risk factor such
as smoking, allows the influence of that risk factor to be studied in
the absence of genetic variability. Genome-wide association scans
are beginning to be performed which allow an agnostic study of
genetic variants in association with LBP, but their results will remain
disappointing until very large cohorts with uniform phenotyping
can be developed internationally and shared for meta-analysis. The
EU project Pain-OMICS is aiming to do this.
11.00-12.30
KEYNOTE LECTURE
Informed consent in the post-Montgomery era
Informed spinal consent after Montgomery - A
BASS sponsored initiative
John Powell
Many hospitals in the UK have no structured spinal consent process
in place and consent is often rather ‘last-minute’ and somewhat
chaotic. This is a surprising state of affairs as spinal surgery is a highrisk surgical specialty and at risk of litigation claims. More recently,
the Montgomery ruling by the UK 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 constituted 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. It will be a welcome tool for many new consultants just
starting in post and for those hospitals without an established
system. In addition, established surgeons might see the benefits of
a system supported by their professional body, within all legal and
professional guidance that will be continually researched, updated
and evidenced. It will demand, however, that time is set aside to
achieve the consent process. In a hard-pressed clinical environment,
the ability to reliably achieve admission on the day for surgery, in
patients at ease with their situation and with little likelihood of late
cancellation will be of great benefit. This consent process should
reduce litigation and improve the patient experience.
BRITSPINE 2016
Montgomery and the Law on informed consent
from reasonable doctor to reasonable patient
Simon Tait
Few areas of medical law cause as much controversy as the law on
informed consent. Arguments about what risks a patients should
be warned of have exercised the courts for decades. The law on
informed consent was substantially altered last year when the
Supreme Court gave its judgment in the case of Montgomery v
Lanarkshire Health Board. Doctors must now ensure that patients
are aware of any material risks involved in a proposed treatment.
A risk will be material if a reasonable person in the patient’s
position would attach significance to it. This is a marked change
to the previous position where the Bolam test applied and the
question was simply whether the doctor’s conduct would be
supported by a responsible body of opinion.
In short, the test is no longer about what the reasonable doctor
considers to be material. Rather it is about what a reasonable
patient considers relevant. The question of whether the
information given was reasonable has shifted from the medics
to the lawyers.
For the consenting doctor this can be a real minefield, although
arguably the law has simply caught up with professional
guidance from the GMC and others. This presentation will look
in more detail at the Montgomery test, how it has been applied
in subsequent decisions and what you can do in practice to
protect yourself from consent claims.
Cumulative Causes
Gerard Martin QC
Introduction
We begin with the “but for” test of causation in material
contribution cases.
•
Bonnington v Wardlaw Castings 1956 AC 613
Pneumoconiosis caused by inhalation of one single agent –
silica dust from two different processes, one tortious and one
non-tortious.
Lord Reid stated
“It appears to me that the source of his disease was both
sources and the real question is whether the dust from the
swing grinders materially contributed to his disease. What is a
material contribution must be a question of degree.”
He went on to conclude that the degree of contribution of
the swing grinder dust was “not negligible” and accordingly the
Defendant was liable.
In Williams, Defence counsel tried to argue that material
contribution only applied to causes applying simultaneously,
that argument was rejected, it was no part of their Lordships
reasoning in Bonnington that the causes had to be simultaneous.
See Lord Toulson para 35.
By contrast compare a cumulative cause case with the situation
in Hotson v East Berkshire HA 1987 AC 70 where what was
before the court were alternative causes.
C fell from a tree and fractured his hip, which was not properly
treated causing avascular necrosis. There were two competing
causes for the injury, the original fall injury or the injury was
caused by the delay in treatment, the court found for the former
as the sole cause and therefore the claim failed.
54
Wednesday, 6th April
By further contrast, a claim will fail if all that can be established is
that the tortious claim was one of a number of possible disparate
causes – Wilsher v Essex Area HA 1988 AC 1074. The tortious cause
must be proved on a balance of probability as a cause, a possibility
is not good enough.
• Bailey V MOD
Surgery for gallstones failed but non-negligent, pancreatitis set
in and was not managed appropriately leaving C in a particularly
weakened state. Later C vomited, due to her weakened condition
she choked on her vomit, she could not breathe and suffered brain
damage.
Careless post-surgery care had materially contributed to her
weakness but the experts could not say that the additional
weakness so caused, was causative of her choking on her vomit.
Put another way the experts could not say “but for” the negligent
cause, the choking would not have happened. This would normally
cause the claim to fail.
process, and therefore materially contributed to the injury to the
heart and lungs” para 42.
•Conclusion
The case is therefore authority for the proposition that if the
negligent cause material contributes to a process eg a weakening
generally, or a sepsis, that will be sufficient for the court to infer that
the negligent cause has contributed to the injury. The contribution
need only be more than a de minimis contribution, something
more than negligible.
What damages are recoverable?
The answer depends on whether the injury is divisible or not –
which will depend on the evidence in each case.
• Dickens v O2
The situation was not a Wilsher type case where there were
competing alternative possible causes. The evidence in Bailey
pointed to cumulative causes.
In this case the Court of Appeal were of the view that psychiatric
injuries were indivisible, Smith LJ expressing her provisional
view because no argument on the point was before her, that
there should not be any rule that the judge should apportion
the damages across the board merely because one non-tortious
(stress not caused by negligence) cause has also been in play.
• Waller LJ
• Hatton v Sutherland
In the Court of Appeal, the above judge giving the lead judgment
relied on Lord Rodgers speech in Fairchild in finding that causation
was established.
By contrast see the different approach taken by Hale LJ in the
above case where she did treat psychiatric injury as divisible.
If the evidence demonstrates on a balance of probabilities that the
injury would have occurred as a result of the non-tortious cause in
any event the claim fails.
If the evidence demonstrates that but for the contribution of the
tortious cause the injury probably would not have occurred the
claim succeeds.
Where medical science cannot establish the “but for” test above,
but can establish that the contribution of the negligent cause was
more than negligible, the but for test is modified and the claim
succeeds. 2009 1 WLR 1052.
• Williams v Bermuda Hospitals Board
C attends hospital with abdominal pain, due to negligent delays
he was not operated on for more than 10 hrs, the evidence was he
should have waited for no more than 5 to 7.5 hrs. When he finally
underwent surgery he had an accumulation of pus in his abdomen
that led to myocardial ischaemia and lung complications. These
led to him requiring life support.
As in Bailey, the experts were unable to say that but for the
negligent 2.2 hrs delay the injury would not have happened.
Lord Toulson’s analysis of the facts of the case was as follows. The
injuries to the heart and lungs were caused by a single known
agent – sepsis from the ruptured appendix. The sepsis developed
incrementally over a period of time of approximately six hours. The
sepsis was not divided into separate components causing separate
damage to the heart and lungs. Its development and effect on the
heart and lungs was a single continuous process. Para 41.
• Cerebral Palsy cases
In an ongoing case I have, our evidence suggests the nontortious cause – hypoxia was ongoing from 4.25 am and causing
brain damage in any event, but also that there was a cumulative
negligent cause ie delay from 4.37 am onwards up to when birth
should have occurred thus creating a negligent period of
damage up to actual birth at 4.45 am. In addition we have at
last 10 mins of delay in resuscitation causing further damage.
Clearly the additional delay was a cumulative cause making a
material contribution to the injury.
However in our case it may be that in the non-tortious stage,
between 4.25 when bradycardia set in to 4.37am when delivery
should have occurred, significant damage has already happened
to the brain stem and basal ganglia such that the foetus would
have sustained cerebral palsy in any event, the damage would
then be divisible, we would have to prove on the balance of
probabilities the later tortious delay made the condition more
severe, and so damages would have to be apportioned.
• General conclusion
The Williams case will have wide impact in clinical negligence
cases in very many sectors where time is of the essence in
determining whether damage occurs – obvious examples
are for example
• in hypoxic injury cases or
• in cases where pressure on the spinal cord continues and
causes permanent damage.
Lord Toulson explained Bailey not on the basis that it was an
exception to the “but for” test but it was an example of taking your
victim as you found her.
His analysis of the facts of the Williams case was:
“In the judgment of the Board, it is right to infer on the balance
of probabilities that D’s negligence materially contributed to the
55
BRITSPINE 2016
Thursday, 7th April
14.00-16.00
SPINE CARE STRATEGY 2020
Getting It Right First Time
Part of the Department of Health’s “Clinically-led
quality and efficiency programme”
Mike Hutton
The programme is part of Lord Carter’s NHS Productivity and
Efficiency Programme and comprises 11 clinical specialties and
utilises a methodology piloted in orthopaedics by Professor Tim
Briggs. It will deliver a systematic review in England of 11 surgical
specialities to identify recommendations to remove unwanted
variation in clinical practice, improve quality outcomes and deliver
efficiencies.
Each project will encourage change through benchmarking,
self-assessment, peer-to-peer review, engagement and national
incentives and levers. Although separate, the work is intended
to be complementary to the programmes being led by Professor
Charles Greenough and Ashley Cole.
Data will be gathered from multiple national datasets (to the
extent that registries are willing to participate) and algorithms
will be constructed to develop a narrative around data. Each
provider will receive a bespoke report and a ‘deep dive’ visit and
a national recommendations report will be published. The DH
and other national bodies will work with the GIRFT team and
professional bodies to develop implementation plans for these
recommendations.
The spinal project, which is being led by Mike Hutton, is being
undertaken in collaboration with the neurosurgical project being
led by Nick Phillips from Leeds with additional spinal neurosurgical
input to be provided by a representative to be identified by the
SNBS. It is the intention that the spinal and neurosurgical deep
dive visits will, where appropriate, take place on the same days to
provide a coordinated approach.
The pathway is a vehicle for implementation of evidence based
care. It is a modular construction and provided by a uniform,
highly skilled workforce (T&T Practitioners). This will allow new
evidence based therapies to be “plugged in” or other treatments
to be discontinued as research and reviews are undertaken.
The implementation will be undertaken on a franchise model
with generic business cases, financial impact assessments, etc.
Regional specialised commissioning teams will work with the
transformation team in each CCG commissioning collaborative
to take this work forward.
Regional Spinal Networks
Ashley Cole - Complex Spinal Surgery CRG Chair
This project aims to improve secondary spinal care across
England by formalising Regional Spinal Networks (RSNs) with
benefits for patients, hospitals, commissioners and consultants.
NHS England is supporting the implementation with 2 fulltime managerial posts initially for 6 months. A template has
been produced showing how these can be started and the core
principles, whilst allowing each Region the maximal flexibility
for structure and function of the RSN. This template has the
approval of all the spinal societies.
The RSN will be composed of a spinal hub(s) with a fully covered
spinal on-call rota, spinal partner hospitals where spinal
surgery is performed, non-spinal partner hospitals where there
is an Emergency Department, but no spinal surgeons and Any
Qualified Providers doing elective spinal surgery outside an
NHS Trust. The RSN will know the spinal and imaging resources
for the region and develop care pathways for emergency
care with an electronic emergency patient referral system to
improve governance. Provision of elective spinal surgery will
be unchanged provided hospitals have the required resources.
Local Spinal MDTs will remain and their function will be more
formalised including collection of Registry data. A Regional
meeting every 4 months will allow spinal surgeons to meet
and discuss complex cases, activity data, outcomes, service
evaluation/audit, research, training, RSN issues and governance
issues. Required resources have been defined and initial
measurement of RSNs will be process based.
National Low Back and Radicular Pain Pathway
Charles Greenough - National Clinical Director for
Spinal Disorders
Back pain is the largest single cause of disability in the UK, with
low back pain alone accounting for 11% of the total disability of
the UK population.
The National Low Back Pain Pathway was devised in 2014 by
a clinical group of 30 stakeholders. The objective is threefold
firstly, to rapidly identify and refer potentially serious pathology,
secondly to provide expeditious access to interventions such as
nerve root blocks or surgical discectomy and thirdly, and most
importantly, provide effective and timely care for sufferers with
acute low back pain to improve outcomes and reduce disability.
The focus is on the promotion of self-management. Standardised
patient literature will be used in conjunction with retraining of
healthcare professionals to de-medicalise simple back pain.
Patients will experience a planned care pathway, including a
high intensity combined physical and psychological treatment
programme. Only after completion of the whole pathway will
consideration be given to surgery for axial back pain (eg, fusion
surgery).
BRITSPINE 2016
56
Wednesday, 6th April
16.30-17.30
One Bone
GRAND MASTERS OF SPINE
Stephen Eisenstein
How the Rheumatoid Neck changed my Clinical
Practice
Alan Crockard
I began my Neurosurgical Training in Belfast in 1969. We
developed artificial ventilation to reduce raised intracranial
pressure and titanium plates to repair skull defects. Arriving
in London in 1978, there were no gunshot wounds, but many
complicated compressive neck deformities.
My steep learning curve began with a patient with progressive
quadriparesis associated with severe rheumatoid AA
subluxation. Posterior occipital decompression and C1/C2
laminectomy allowed neurological recovery, but only in the
supine patient. The vertical position produced paralysis and
ultimate demise. Bonney at St Mary’s and Menezes in Iowa had
described improvement with transoral odontoidectomy. Dorsal
fixation remained difficult until Andrew Ransford produced the
occipitocervical loop and with him a most productive team
approach to complex spinal conditions ensued.
In the mid-80s, there seemed to be an “epidemic” of rheumatoid
AA subluxations and this resulted in the publication of the
largest prospective study on surgery for the condition. Transoral
surgical instruments allowed expansion of the approach for
tumours and congenital abnormalities.
Thirty years later, the situation had changed. Endoscopic
techniques allowed less traumatic approaches to the ventral
craniovertebral junction for all pathology. Dorsally, rod and
screw constructs allowed fixation with occipital sparing and
thus useful head on neck movement. And the great surprise - a
14-fold reduction in RA AA subluxation. Current thinking is that
the pathology which began my quest was iatrogenic, caused by
the treatment of RA with steroids. And the lessons:
- never stop asking “why”
- constantly reassess one’s theories and practice
- a team approach to the complicated
This is the story of a very successful low cervical osteotomy
to correct a congenital kyphosis in a 14-year-old girl with
congenital failure of segmentation of the whole spine; a unique
case of a ‘one-bone’ spine. The result was catastrophic for the
trachea and oesophagus and briefly for the spinal cord. The
lesson is that soft tissues may be more resistant to correction
even than bone.
Tuberculosis of the Spine
Alistair Thompson
The challenge of the surgical management of tuberculosis of
the spine contributed directly to the development of surgical
techniques and management in all aspects of spinal disease.
These issues are ongoing with respect to medicolegal aspects
of negligence.
The Operation that Changed my Life
John Webb
For as long as I can remember I was going to be a surgeon. I
trained at the Robert Jones and Agnus Hunt Orthopaedic
Hospital. Initially, under the guidance of B T O’Connor, I
obtained a Paediatric Fellowship with Dr Sherman S Coleman at
Salt Lake City. J O’Brien arrived at Oswestry, introducing me to
a new world of anterior and posterior approaches from base of
skull to the sacrum. He was a lateral thinker and had a particular
interest in spinal pain.
The ability to undertake anterior or posterior approaches to the
spine for a particular pathology gave one more options. Surgical
decisions were not hampered by lack of surgical techniques.
There was no specific operation or paper that influenced my
decision to be a spinal surgeon. There was no one specific
operation that confirmed that my decision to become a spinal
surgeon was correct.
An operation had been arranged to perform an anterior
vertebrectomy at the Th8 level for an old Tb kyphotic spine,
with increasing neurological symptoms in his legs - he was
losing the ability to walk. This was a most difficult case and the
surgery had been organised for visiting professors, including
David Bradford.
The patient anaesthetised, I had been instructed to undertake
the surgical approach. A message arrived that Mr O’Brien had
developed viral pneumonia and would I continue the operation.
As you can imagine it was a technically demanding case. I shall
never forget David Bradford’s face when he realised that a
senior registrar was showing the mighty man how to undertake
a vertebrectomy. Fortunately all went well!
57
BRITSPINE 2016
Thursday, 7th April
Thursday 7 April
Scoliosis Research Society (SRS)/British
Scoliosis Society (BSS)
08.30-08.50
Reducing risk in scoliosis surgery
John P Dormans, MD
Safety quality and value are central to the discussion of spinal
deformity surgery. This is not only of major interest to patients
and families but also surgeons, payers, government officials
who are involved with healthcare, etc. This talk will review some
of the efforts that are occurring globally to try and make an
impact in these 3 separate, but related areas (ie, safety, quality
and value). Specific projects will be highlighted. The cost benefit
ratio will be discussed, as will whether or not these efforts are
truly making an impact to reduce risk in scoliosis surgery.
08.50-09.10
Quality of life in adult scoliosis
Ferran Pellisé
The total number of adult spinal deformity (ASD) surgeries has
more than doubled in the last decade. This compares to an
increase of just 20% in the frequency of surgery for all other
spinal primary diagnosis codes over the same time period. As
a result of the increasing frequency and high cost of surgery,
health care providers are under intense pressure to quantify the
clinical effectiveness and cost-effectiveness of the treatments
provided for ASD and of other complex spine surgery.
In a recent study (Pellisé F et al, ESJ 2015) we compared the
relative burden of ASD with that of common chronic conditions,
using the SF-36 health survey and IQOLA published data. Our
study demonstrates that the physical burden of ASD is large
compared with other self-reported chronic conditions in the
general population. The difference in scores for patients with
ASD compared with those reporting no medical conditions was
greater than -30, indicating a very large effect size ([1.3SD). Selfreported arthritis, the condition with the highest impact on BP
in the IQOLA project, presented an adjusted deviation from the
reference healthy group of -14.
09.10-09.30
Techniques and strategies in the surgical
management of coronal and sagittal unbalanced
deformities
Daniel Chopin
Fixed sagittal imbalance has been identified as a major source
of pain and disability in adult patients and restoration of a wellbalanced spine plays a major role in improvement of reported
patient outcome quality. Powerful and aggressive surgical
techniques have been described to address the problem, but
with higher rates of complications, sometimes without reaching
the optimal spinopelvic balance.
Measurement tools of the sagittal alignment and the
compensatory mechanisms provide the basis for pre-operative
planning with corrective simulation, pre-operative control,
expecting the optimal correction for a particular patient.
In a standing position, every single patient has its own
economical posture where the pelvis is the main regulator of
chain of correlation between spine curvatures and lower limbs.
With pathological sagittal malalignment, PI being constant and
not modified, it serves as a reference to evaluate the theoretical
value of the other parameters and compare to the actual values
of the patient.
It allows to tailor the ideal objective of an economical
sagittal spinopelvic balance of a single patient in its specific
unbalanced situation. It can, therefore, be decided extension
of instrumentation, preferred strategy of posterior approach,
level, type and amount of correction, or anterior opening with
cages through minimally invasive approach, keeping in mind
the importance of the lumbo-sacral junction for coronal and
sagittal balance.
Planned corrective osteotomies can be controlled during the
surgery with measured pre-operative X-rays in order to avoid
suboptimal (more frequent) or over correction (possibly with
low pelvic incidence).
Better surgical planning may reduce the risk of suboptimal
correction and participates to outcome improvement.
However, it is done from a static view at one time of a complex
neuromuscular regulation. Evolution with time and age of
unfused segments could be unpredictable and needs more
study.
The ‘‘ideal’’ treatment for ASD is very difficult to identify with the
present state of the art of research in this field. Although this
disorder is getting recognition as a genuine health problem
in an ever aging population, well structured clinical trials
comparing different approaches and treatment modalities
are very difficult to find. Our data (Mannion AF et al, ESJ 2015)
(Acaroglu E et al, ESJ 2016) show that in the short term (1-2y
f-up), patients treated conservatively demonstrate a very low
likelihood of having a favourable outcome (6.7 %) compared to
those treated surgically (42 %).
BRITSPINE 2016
58
Thursday, 7th April
Podium Presentations
Combined BASS/SBPR
(13) 08.30-08.40
Predictors of self-management in patients with
chronic low back pain: study protocol
Main Author: Anirban Banerjee1,2
Co Authors: Paul Hendrick1, Holly Blake1
Affiliation: 1The University of Nottingham; 2Nottingham
CityCare Partnership
Conflicts of Interest: No conflicts of interest
Funding Sources: Vice-Chancellor’s Scholarship for
Research Excellence
Background Context: Self-management (SM) can be
defined as individual’s ‘ability to manage the symptoms,
treatment, physical and psychological consequences and
life-style modifications’. SM programmes for patients with
chronic low back pain (CLBP) have failed to show clinically
meaningful improvement in pain and disability, which
potentially reflects difficulty in treatment matching in
absence of extensive research on predictors of SM.
Purpose: The purpose of this study is to identify predictors
of SM and its change over time in patients with CLBP.
Study Design/Setting: Prospective non-experimental
longitudinal cohort (multi-centre)
Patient Sample: Community ambulant adults (1865 years), who are attending/attended outpatient
physiotherapy treatment for their CLBP will be recruited (n=
approx. 400). Patients with specific causes of CLBP including
spinal surgery/deformity, grade III/IV spondylolisthesis,
severe spinal canal stenosis, disc protrusion/extrusion,
ankylosing spondylitis; pregnancy; neurological and
cognitive impairments will be excluded.
Outcome Measures: Self-reported validated measures
for SM, pain intensity, disability, physical activity level,
kinesiophobia, catastrophising, depression and global
impression of change will be used.
Methods: Eligible and consenting participants will
complete questionnaires at baseline and six months.
Descriptive statistics and multiple regression will be
employed. This protocol is ethically approved and
registered (ClinicalTrial.gov ID: NCT02636777).
Results: Not applicable
Conclusions: Study results will inform patient selection
and future development of tailored and targeted SM
programmes for patients with CLBP.
(14) 08.40-08.50
Patient reported outcome measures: the accuracy of
patient reported revision spinal surgery
Main Author: Elmajee Mohammed
Co Authors: Aljawadi Ahmed, Ben-nafa Walid, Rajat Verma,
Saeed Mohammad, Siddique Irfan
Affiliation: Salford Royal NHS Foundation Trust (SRFT)
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
59
Background Context: Patient reported outcome measures
form a major part of registry data collection and, beyond
functional outcome scores, may be utilised to establish
whether patients have undergone revision spinal surgery
and additionally whether this was performed at the same
or a different spinal level.
Purpose: We aimed to establish the accuracy of patient
reported revision surgery
Study Design/Setting: Analysis of prospectively collected
data
Patient Sample: 4,247 patient reported outcome
measures collected at 3 months postoperatively
Outcome Measures: Validation against patient’s electronic
patient records
Methods: 4,247 patients who completed PROMS at 3
months postoperatively between August 2011 and August
2015 were included in the study. The surgical history of
these patients was accessed to compare it with the answers
obtained from the patients’ questionnaire. Any intervention
including revision surgery, management of complications,
and spinal injection from the time of the last lumbar
surgery to date of the questionnaire were noted and
compared with the responses given by patients.
Results: A number of 4,143 patients reported no further
surgeries. 4,116 out of 4,143 patients were truly negative,
and 27 were false negative as they had further surgical
interventions.
104 patients reported revision surgery. 72 patients out of
104 were truly positive and described the correct segment,
whereas, the remaining 32 patients were falsely positive.
This is because they had no surgeries, spinal injections,
or surgery at a different level. Thus the sensitivity of this
question was found to be 72.7%, and specificity 99.2%.
Conclusions: This study demonstrates the utility of this
question to assess the revision surgery rates in spinal
surgery. However, with the lower than expected sensitivity,
revision rates may be reported by patients as higher than
they actually are.
(15) 08.50-09.00
The effect of classification-based cognitive
functional therapy on spinal kinematics and
function in subgroups of chronic low back pain
Main Author: Liba Sheeran
Co Authors: Sarah Jones, Rebecca Hemming, Robert van
Deursen, Valerie Sparkes
Affiliation: Cardiff University, School of Healthcare
Sciences, Eastgate House, Cardiff CF24 0AB
Conflicts of Interest: None
Funding Sources: National Institute of Social Care and
Health Research, Wales
Background Context: Chronic low back pain (CLBP) is
a global problem with effective treatments unknown.
Heterogeneity is thought responsible for lack of success.
Classification-based cognitive functional therapy (CB-CFT)
targeting person’s pain mechanisms demonstrated efficacy.
CB-CFT effect on spinal movement and function has not
been studied.
Purpose: To investigate CB-CFT effect on 3D spinal
kinematics and function.
BRITSPINE 2016
Thursday, 7th April
Study Design/Setting: Pragmatic randomized clinical pilot
study in Primary Care Outpatients Physiotherapy
Patient Sample: 23 CLBP patients sub-classified with
flexion and extension control impairment
Outcome Measures: Physiologic: Spinal movement range
(ROM) during flexion-extension, reaching, lifting. Selfreported: Oswestry Disability Questionnaire (ODQ), pain
(VAS), Tampa Scale of Kinaesiophobia (TSK), Distress &
Risk Assessment Method (DRAM) Functional: International
Physical Activity Questionnaire (IPAQ).
Methods: Participants were randomized into CB-CFT
(n=13), current best practice (C) (n=10). Unpaired T-test
assessed mean change between-group difference (p>0.05).
Funding: National Institute of Social Care and Health
Research, Wales. No conflicts of interest.
Results: No between-group differences at baseline,
CB-CFT showed significant increase in lumbar ROM
during flexion-extension and thoracic ROM during lifting
compared to reduction in C. No between-group differences
shown in thoracic ROM during flexion-extension,
thoracic & lumbar ROM during reaching. Statistically
significant improvements demonstrated in disability
(ODQ)[CB-CFT=14.9(8.0),C=5.2(12.4)], pain (VAS)[CBCFT=2.1(1.5),C=0.7(1.8)], TSK[CB-CFT=12.4(7.2),C=4.1(2.6)],
IPAQ[CB-CFT=1855.6min(1085),C=19min(1672)]. DRAM
between-group change wasn’t significant
Conclusions: Preliminary evidence for positive effect on
spinal kinematics and function were demonstrated to
inform full scale RCT.
(16) 09.00-09.10
Improving MRI diagnosis following whiplash injury
by routine imaging of the cranio-cervical junction in
addition to the cervical spine
Main Author: Francis W Smith
Co Authors: Steven Morgan
Affiliation: Medserena Upright MRI Centre, 114a Cromwell
Road, London SW7 4ES
Conflicts of Interest: None
Funding Sources: None
Background Context: The cost implications both in terms
of patient suffering and financial, of under diagnosis
of mechanical damage at the cranio-cervical junction,
following whiplash injury is very large.
Purpose: It is important to ensure that the entire region
involved in a hyper-extension injury is fully assessed. The
current accepted practice of only MRI scanning the cervical
spine is less than ideal and a new more thorough protocol is
proposed.
Study Design/Setting: Patients were studied seated in an
Upright MRI scanner, employing sagittal T1 & T2 & axial T2
images from C2 to T1, with the neck in neutral, flexion and
extension. The cranio-cervical junction was imaged using
coronal and axial images from the skull base to C2. Further
axial images with the head rotated to the right and the left
were made.
Patient Sample: 50 symptomatic patients 15 - 72 yrs. (Mean
44yrs), previously investigated following hyperextension
injury of the neck, with a reportedly normal previous MRI
examination of the cervical spine, were examined
BRITSPINE 2016
Outcome Measures: Spinal alignment, disc integrity,
alignment of the atlanto axial-joints and atlanto-occipital
joints, alar and cruciate ligament integrity and cerebellar
tonsillar station were assessed in all cases. In addition
measurements to assess for basilar invagination were made.
Methods: All measurements were made by both authors
independently and subsequently correlated. Neither author
received remuneration for this work.
Results: In over 50% of patients (27), no additional
information was gained. In the other 23 patients, 18 showed
ligamentous damage at the atlanto-axial joint, of which
12 had dislocation. The other 5 showed instability on the
rotation images. 2 of the 23 patients also had atlantooccipital joint dislocation. Cerebellar tonsillar ectopia was
seen in 12 patients.
Conclusions: The current practice of limiting imaging to
below C2 is inadequate and under-estimates the incidence
of post-traumatic ligamentous damage. For thorough MRI
examination, imaging of the cranio-cervical junction is
important, to find or exclude ligamentous damage.
(17) 09.10-09.20
Early results of hybrid cervical disc arthroplasty results from a single centre
Main Author: S Khan
Co Authors: M Rajesh, S Friesem, C Bhatia, K Aneiba, G
Reddy
Affiliation: University Hospital of North Tees, Hardwick
Road, Stockton-on-Tees, Cleveland TS19 8PE
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: The clinical outcomes for Hybrid
Cervical Arthroplasties are variable. There is no agreement
on the term “Hybrid” although “Hybrid” in arthroplasty
is universally understood as a fusion combined with
arthroplasty, it does not clarify how many levels of fusion
or arthroplasty are in the single construct. We did a
grouped retrospective review of prospectively collected
data comparing the outcomes of Hybrid arthroplasties
that had fusion at a different level at the same time. All
these procedures were followed for minimum 2 years. The
indications for Hybrid Cervical Arthroplasty were structural
kyphosis and lack of motion at one or more pathologic disc
levels.
Purpose: To look at the clinical outcome of Hybrid Cervical
Arthroplasty
Study Design/Setting: Retrospective Review of
Prospectively collected data
Patient Sample: 22 patients
Outcome Measures: NDI (Neck Disability Index),
Depression, Anxiety, Bodily Pain, Visual Analogue score for
Neck (VAS Neck), and Visual Analogue score for Arm (VAS
Arm)
Methods: Our study involved a retrospective review
of prospectively collected data on all hybrid cervical
constructs in which Nunec (Pioneer Surgical Technology,
USA) and Discocerv (Alphatec, USA) disc replacements were
used from July 2006 to June 2013. Clinical Outcomes were
prospectively reviewed using data including NDI (Neck
60
Thursday, 7th April
Disability Index), Depression, Anxiety, Bodily Pain, Visual
Analogue score for Neck (VAS Neck), and Visual Analogue
score for Arm (VAS Arm). Scores were collected preoperatively and at each follow up at 3 months, 6 months, 1st
and second year. Paired T-test was used to analyse the data
for statistical significance.
Results: We had 22 patients in our study consisting of
12 females and 10 males with an average age of 63 years
(age range: 51-75) who received a hybrid construct. Mean
duration of symptoms was 43 months. The indication
for surgery was radiculopathy and a combination of
radiculopathy and myelopathy. Significant improvements
in mean clinical scores were noted in our study with
improvement in NDI score from 51.45 to 37.5 (P value:
0.001), Anxiety score from 8.91 to 7.02 (P value: 0.032), Bodily Pain score from 27.27 to 44.40 (P
value: 0.005), VAS Neck from 6.81 to 4.08
(P value: 0.000) and VAS Arm from 6.38 to 3.55. (P value:
0.000). The mean Depression score changed from 8.72 to
7.40; however the P value was 0.101.
Conclusions: Our results showed favourable outcomes in
terms of NDI, VAS Neck and VAS Arm with Hybrid Cervical
Arthroplasty procedures presenting them as an effective
treatment strategy in the management of severe cervical
degenerative disease.
(18) 09.20-09.30
Predictive factors of outcome following ACDF – a
study of 611 patients
Main Author: Thomas Finnigan
Co Authors: Iain McLaughlin-Symon, Gagan Sethi, Rajat
Verma, Naveed Yasin, Saeed Mohammad, Irfan Siddique
Affiliation: Salford Royal Foundation Trust
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: There have been multiple studies
attempting to identify preoperative factors that influence
outcomes following ACDF. This is the largest study looking
at this in detail.
Purpose: The aim of this study was to determine
preoperative factors that influenced outcome following
surgery.
Study Design/Setting: Prospectively collected registry
data was analysed for patients between August 2011 and
June 2015
Patient Sample: 611 consecutive patients who underwent
anterior cervical discectomy and fusion
Outcome Measures: Visual Analogue Score and COMI
scores pre and postoperatively
Methods: Multivariate regression analysis, student t test
and ROC curves were used to evaluate factors associated
with outcome.
Results: At 3 months, 336 (67.47%) of patients had a good
outcome. Predictors of poor outcome were a higher preoperative COMI score, patients who underwent surgery for
sensory/ neurological symptoms and smokers. When the
VAS of arm pain was more than 6 the risk of a poor outcome
nearly doubled.
Conclusions: Our study has shown that patients with
significant preoperative limb neurological symptoms (i.e.
61
worse arm pain, pre-op sensory/neurological symptoms)
and smokers have a worse outcome following primary
anterior decompression and fusion surgery.
(19) 09.30-09.40
‘I think positivity breeds positivity’: a qualitative
exploration of the role of family members in
supporting those with chronic musculoskeletal pain
to stay at work
Main Author: Serena Bartys
Co Authors: Haitze de Vries, Michiel Reneman
Affiliation: Centre for Applied Psychological & Health
Research, University of Huddersfield, Queensgate,
Huddersfield HD1 3DH
Conflicts of Interest: None
Funding Sources: BUPA foundation and Instituut Gak.
A Society for Back Pain Research travel fellowship was
awarded to the presenting author to build on this UK-Dutch
collaboration.
Background Context: It is proposed that ‘significant
others’ (spouses/partners/close family members) are
important sources of support in helping those with
chronic musculoskeletal pain to remain at work, but the
phenomenon remains largely unexplored.
Purpose: To add to the under-represented ‘social’
dimension of the biopsychosocial model currently applied
to our understanding and treatment of pain
Study Design/Setting: A secondary analysis of qualitative
data collected in two un-related studies conducted in the
UK and the Netherlands.
Patient Sample: In the Netherlands, workers with chronic
musculoskeletal pain and their significant others were
recruited via a newspaper advertisement (n=21), and in the
UK via a hospital-based pain management clinic (n=10).
Outcome Measures: In both studies, qualitative data
exploring the role of significant others in supporting their
relative’s continued work participation were collected via
semi-structured interviews using an almost identical openended question.
Methods: Thematic analysis techniques were applied to
both sets of qualitative data independently, and data were
then assimilated to establish common themes. Each study
was funded and conducted independently, and in order to
ensure credibility of assimilated data, a set of procedural
steps were undertaken by a member of each study team in
accordance with published recommendations.
Results: Three common themes were identified ‘connectivity’, ‘activity’ and ‘positivity’. Worker and significant
other responses were largely congruent, but significant
others provided more in-depth information on the nature
of their support, their concerns and the impact on their
relationship.
Conclusions: The findings of this study point to harnessing
support from ‘significant others’ as an effective strategy in
the treatment and management of chronic musculoskeletal
pain.
BRITSPINE 2016
Thursday, 7th April
(20) 09.40-09.50
A systematic literature review of pain and disability
outcomes of pain neuroscience education in the
management of chronic low back pain
Main Author: Lianne Wood
Co Authors: Paul Hendrick, Nasir Quraishi
Affiliation: Queens Medical Centre Spinal Outpatient
Department
Conflicts of Interest: None
Funding Sources: None
Background Context: Pain neuroscience education is
employed in patients with chronic low back pain (CLBP) to
reduce pain related behaviours. However, its efficacy has
not been systematically evaluated.
Purpose: The aim of this review is to systematically
evaluate the literature regarding pain neuroscience
education in patients with chronic low back pain.
Study Design/Setting: Systematic review and meta-analysis.
Patient Sample: Patients with Chronic Low Back Pain
(CLBP)
Outcome Measures: Pain and Disability scores (RMDQ)
Methods: A literature search of Cinahl, Medline, Web
of Science, Scopus, Cochrane and Science Direct was
performed from 2011 (01) to 2015 (07). Appraisal and
synthesis was assessed using the CONSORT and Cochrane
Risk of Bias Tool. The main outcome measures assessed
were pain and disability. Pain and disability scores were
collated and meta-analysis was performed where possible.
Results: Three of the four included studies were of
moderate quality with one study of high quality according
to the Cochrane risk of Bias tool. 3 Papers assessed PNE in
CLBP and one evaluated PNE in a preoperative subgroup.
Meta-analysis was performed excluding the preoperative
paper for homogeneity, Statistically significant but clinically
small improvements in chronic low back pain were
demonstrated for short-term pain: overall mean difference
(OMD) 0.77 (95% confidence interval 0.00; 1.55) (n=101)
(p=0.05). Disability scores showed a statistically and
clinically significant improvement in the RMDQ (p=0.003):
OMD of 3.23 (95% confidence interval 1.12; 5.34) (n=39).
Conclusions: The addition of pain neuroscience education
to usual care in a CLBP subgroup generated improved pain
and disability scores in the short- and medium-term. Further
powered RCT’s are required to support these findings.
(21) 09.50-10.00
Clinical usefulness and safety of selective lumbar
nerve root blocks
Main Author: Grzegorz Rudol
Co Authors: Darren Richardson, Ata Kasis, Cyrus Jensen
Affiliation: Spinal Unit, Leeds General Infirmary, Leeds
Conflicts of Interest: None
Funding Sources: None
Background Context: Nerve root blocks in the treatment
of radicular and central canal stenosis symptoms are
controversial.
BRITSPINE 2016
Purpose: Analyse efficacy, safety and usefulness of this
procedure performed by a fellowship trained spinal surgeons.
Study Design/Setting: Selective nerve root block(s) for
lumbar radiculopathy or central stenosis were carried;
followed up at 6 weeks and 6 months.
Patient Sample: 550 patients with more than 6 weeks
lasting symptoms.
Outcome Measures: VAS for pain, length of improvement,
achieving ‘cured’ status at the six-month follow-up,
postponing or avoiding surgical intervention.
Methods: Injections: 40mg methylprednisolone and 3 ml
of 0.25% bupivacaine.
Statistical analysis: logistic regression.
Results: Underlying pathology was radiculopathy (225–
41%), central canal stenosis (96-17.5%), mixed (210-38.2%).
78 (14.2%) patients had noticeable one-week improvement,
152 (28%) up to 3 months, 224 (40%) more than 3 months.
In six-month follow up 125 (23%) patients regarded
themselves as ‘cured’. 249 (44.5%) patients did not require
any surgical intervention nor spinal follow as regarded
improvement was satisfactory. Logistic regression identified
gender, age, and underlying pathology as predictive of
immediate and prolonged satisfactory response following
nerve root blockage. Most likely to respond was a male
with a predominantly radicular pain; advancing age
increased one’s chances for a satisfactory outcome. None of
the patients developed any significant complications.
Conclusions: Nerve root blocks are a safe option for
radiculopathic and stenotic patients. They play an
important diagnostic role and in planning/avoiding
potential spinal surgery. A significant proportion (82.5%)
of patients experienced some relief of symptoms and for
many this was a lasting benefit which led them to avoid the
need for surgery.
(22) 10.00-10.10
The differential effects of norepinephrine and
dopamine on cerebrospinal fluid pressure and
spinal cord perfusion pressure after acute human
spinal cord injury
Main Author: Brian K Kwon
Co Authors: Farhaan Altaf, Donald E Griesdale, Lise Belanger,
Leanna Ritchie, Tamir Ailon, Michael C Boyd, Scott Paquette,
Charles G Fisher, John Street, Marcel F Dvorak
Affiliation: University of British Columbia and Vancouver
General Hospital
Conflicts of Interest: None
Funding Sources: None
Background Context: The choice of vasopressor used
in spinal cord injury (SCI) is typically dictated largely by
physician and/or institutional preference.
Purpose: We examined how two vasopressors
(norepinephrine and dopamine) affected intrathecal CSF
pressure and the corresponding spinal cord perfusion
pressure (SCPP).
Study Design/Setting: Acute SCI patients were evaluated
in this study in which lumbar intrathecal catheters were
inserted to monitor intrathecal CSF pressure and then
simultaneous monitoring of MAP and intrathecal pressure
was conducted for 3-5 days post injury.
62
Thursday, 7th April
Patient Sample: Acute SCI patients over the age of 17 with
cervical or thoracic ASIA Impairment Scale (AIS) A, B, or C
injuries were enrolled in this study.
Outcome Measures: Measurements of MAP, ITP and SCPP
Methods: Two vasopressors were evaluated in a “crossover
procedure” to directly compare their effect on ITP. Intrathecal
pressure (ITP), mean arterial pressure (MAP), and heart rate
(HR) were being continuously measured.
Results: A total of 11 patients were enrolled and included
in our analysis. The cohort included 10 subjects with
cervical injuries and 1 subject with thoracic injuries. We
performed 24 crossover interventions in these 11 patients.
There was a decrease in ITP with norepinephrine resulting
in an increased SCPP during the norepinephrine infusion
when compared to dopamine (67±1mmHg vs 65±1mmHg
respectively, p=0.0049).
Conclusions: In conclusion we found that the choice of
vasopressor used does have an effect on CSF pressure
independent of the MAP, thereby influencing SCPP.
Norepinephrine was able to maintain MAP with a lower
ITP and a correspondingly higher SCPP as compared to
dopamine in this study.
(23) 10.10-10.20
Is frailty prevalent in older people admitted to
hospital with osteoporotic vertebral fragility
fractures (VF)?
Main Author: Yat Yee Shizuka Chan
Co Authors: Lihxuan Goh, Terence Ong, Opinder Sahota
Affiliation: Department for Healthcare of Older People,
Nottingham University Hospitals NHS Trust, Nottingham
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: VFs are associated with significant
mortality, despite adjustment for significant comorbidities. This has been attributed to frailty within this
cohort.
Purpose: This project aimed to identify the degree
of frailty within this group using well described frailty
indices.
Study Design/Setting: Prospective observational study
as part of a VF quality improvement project in a UK
university teaching hospital.
Patient Sample: Patients ≥65 years old with a VF
Outcome Measures: Patients’ characteristics, mobility
(timed-up-and-go, TUG), function (Barthel), cognition
(abbreviated mental test, AMT) and frailty indices
[PRISMA-7, Groningen Frailty Index (GFI) and Edmonton
Frail Scale (EFS)].
Methods: Data was collected prospectively over a 6 week
period.
Results: 24 patients [16 female (66.7%); 8 male (33.3%)]
with a mean (SD) age of 81(8.26) were evaluated.
Pertaining to patient characteristics, average comorbidities were 3 per-patient; 19 patients (79.2%) were
admitted with a fall; 75.0% had a fall in the last year (range
1-10); 83.3% were taking ≥4 medication; 29.2% needed
assistance with daily living; Barthel mean(SD) was 17(4);
AMT mean(SD) was 8(3); 75.0% needed >20seconds to
perform a time-up-and-go test. Fractures were centered
63
on the thoraco-lumbar region (T7-L5; 94.3%). Fracture at
one level was detected in 70.8%; two level in 20.8%; and
three or more in 8.3% of patients studied. Using PRISMA-7
70.8% were identified as frail; 66.7% based on GFI; and
54.2% vulnerable to frailty using the EFS.
Conclusions: A significant proportion of patients with
VF in hospital are frail with old age co-morbid conditions.
Hospital treatment needs to include management of
their frailty using a multidimensional interdisciplinary
comprehensive geriatric assessment.
(24) 10.20-10.30
Is the thoracolumbar injury classification and
severity score (TLICS) applicable to UK practice?
Main Author: Peter Loughenbury
Co Authors: James Tomlinson, Chantelle Mann, Jonathan
Lamb, Robert Dunsmuir, Peter Millner, Abhay Rao, Almas
Khan, Nigel Gummerson
Affiliation: Leeds General Infirmary, Great George Street,
Leeds LS1 3EX
Conflicts of Interest: No conflicts of interest.
Funding Sources: No funding obtained.
Background Context: The TLICS (thoracolumbar injury
classification and severity score) is designed to help classify,
and propose management for, thoracolumbar spine
fractures. Several studies have reported good reliability
and validity but to date no UK data has been reported.
Several of these series have MRI studies for all patients,
which does not reflect UK practice.
Purpose: To assess the reliability of TLICS in specialist UK
spinal surgery practice.
Study Design/Setting: Retrospective case series review.
Patient Sample: All patients admitted between January
2013 and January 2014 with spinal trauma.
Outcome Measures: Inter-rater reliability of the
thoracolumbar injury classification and severity score using
Kappa-Fleiss method.
Methods: Clinical and radiographic data for 130 patients
was reviewed by three spinal surgeons. Injuries were
scored independently using the TLICS classification. FleissKappa values were calculated to assess inter-rater reliability.
The actual management was compared with the TLICS
algorithm to evaluate validity.
Results: The inter-rater k coefficient was 0.55 (CI 0.470.63) for proposed TLICS management category. This
represents moderate agreement. TLICS 0-3 (non-operative
management) k = 0.61 (substantial agreement). TLICS 4
(surgeons choice) k = 0.15 (slight agreement). TLICS >4
(operative management) k = 0.68 (substantial agreement).
22 patients had a mean score >4 (operative management)
and 17 of these had surgical stabilisation. No patients with
a mean score <5 underwent surgery.
Conclusions: TLICS has moderate reliability and validity
for use in UK trauma patients. To our knowledge this has
not previously been evaluated in the UK but is comparable
to previous studies worldwide. Perhaps unsurprisingly
the poorest reliability is for patients in the operative/nonoperative management category (TLICS=4). Importantly
the category suggesting surgical treatment (TLICS >4) has
highest inter-rater reliability.
BRITSPINE 2016
Thursday, 7th April
10.10-11.00
The ‘MAGEC’ debate – Trick or Treat
FOR
Treat is the Trick: Why and how do I insert
Magnet-driven Growing Rods (MdGR)
Hilali Noordeen/Nanjundappa Harshavardhana
Magnet-driven Growing Rods (MdGR) have revolutionised
the surgical management of early-onset scoliosis (EOS) by
eliminating repetitive anaesthesia and invasive distractions.
This talk provides a brief summary in the evolution of MdGR
technology over the past few years with valuable practical
tricks and pearls of the surgery. The unique device specific
complications (DSC) that contributed to the development of a
reliable second generation MdGR which eliminated the device
flaws using case examples is presented. A case for further
research warranting the need for a third-generation MdGR
addressing the limitations of current technology is highlighted.
My surgical technique of dual submuscular MdGR insertion
using two mini-incisions and rail-roading the rod that is
attached to proximal/distal anchors with the importance of
‘Taj Mahal’ proximal anchors configuration is highlighted. The
effect of MdGR insertion on pulmonary function and immense
benefit in children with EOS secondary to neuromuscular and
syndromic scoliosis at two years is presented. The consequences
of subjecting a child with MdGR to an MRI scanner and the
effect of strong magnetic field on the magnetic coil mechanism
are discussed. Finally the cost-effectiveness model with use of
this novel technology that resulted in at least 40% savings over
the conventional growing rods (CGR) applicable to the UK – NHS
at 5 years in 9 patients is presented.
In summary, MdGR maybe an attractive one-off surgical
undertaking eliminating the need for definitive spinal fusion in
select cohort of EOS and is likely to be the ‘standard of care’ in
near future.
MAGEC - Charlatan or Messiah?
Colin Nnadi
MCGR technique effectively controls radiological parameters
and provides stable deformity correction in early-onset
scoliosis. This procedure reduces the need for multiple
surgeries and lessens complications from surgery compared
to traditional growing systems. It gives greater independence
to patients and families and provides cost savings to the
health service. It is the only paediatric deformity device in
the UK to have undergone a full evaluation process by the
National Institute for Clinical Excellence (NICE) and receive
device exclusion funding (£5,000/rod) by NHS England.
are difficult to manage non-operatively, surgical management
is the mainstay of treatment and various devices are available
to be utilised. The main challenges to address are controlling
the curvature and allow spinal growth and thus allow normal
physiological growth of the viscera.
The MAGEC device has been a significant technological
advancement in surgical management of EOS. We were one
of the early centres to adopt the use of this device and had
favourable early results with the device which addressed
the above 2 challenges and, as an added bonus, had fewer
complications compared to conventional growth rods.
But as like any new technology there are concerns and, with
time, these become apparent and we have encountered some
complications which were not the case with the conventional
growth rods which has made us question the real advantages
of this device in young children for the management of EOS.
10.30-11.00
British Spine Registry
Mike Hutton
Data Input: www.spineregistry.co.uk
Information Website:
www.britishspineregistry.com
The British Spine Registry (BSR) has seen some healthy growth
since June 2015. There is still a long way to go!
There are now 41,921 patients registered on the BSR, a 13%
increase since June 2015. There are 815 users registered on the
system, 209 of these are actively entering data, a rise of 20%
since June 2015.
A new update to the registry will be demonstrated which will
include new features such as:
1. Obvious mandatory field capture.
2. The ability to turn on and off mandatory fields view.
3. An operation note print facility.
4. Integrated audit forms for Cauda Equina Syndrome and
Magnetically Controlled Growing Rods. (Mention Cauda Equina
Syndrome in your assessments of patients on the registry and further relevant questions are asked).
5. The ability to record whether the case is NHS or
independently funded.
6. A widget reporting section - a simple and easy way for
present this at
users to look at their outcome data and revalidation.
The current practical and political challenges around outcome
data facing spine surgeons in the UK will be discussed.
The BSR has visited a number of centres across the UK over the
last 6 months, helping units understand the requirements and
costs of effective data capture.
Any unit needing assistance in doing so can contact us (audit@
spinesurgeons.ac.uk) to arrange a team registry visit providing
a free and independent report on ‘how to set up the registry
for your unit’ or to work on uploading existing data onto the
registry.
AGAINST
Sashin Ahuja
As most paediatric deformity surgeons would agree, early
onset scoliosis (EOS) management is challenging. Over the
years the management of EOS has gone through various
advances including surgical and non-surgical. In cases which
BRITSPINE 2016
64
Thursday,3rd
7thApril
April
Thursday,
Podium Presentations
British Scoliosis Society (BSS)
(25) 11.30-11.40
Povidone-Iodine (PVI) has a profound effect on
in vitro osteoblast proliferation and metabolic
function and inhibits their ability to mineralise and
form bone
Main Author: Matthew Newton Ede
Co Authors: Ashleigh M Philp, Andrew Philp, Stephen M
Richardson, Saeed Mohammad, Simon W Jones
Affiliation: The Royal Orthopaedic Hospital, Bristol
Road South, Birmingham B31 2AP; The University of
Birmingham, MRC-ARUK Centre for Musculoskeletal Ageing
Research, Medical School, Queen Elizabeth Hospital,
University of Birmingham B15 2WB; The University of
Manchester, Centre for Tissue Injury and Repair, Institute of
Inflammation and Repair, Faculty of Medical and Human
Sciences, Stopford Building, Oxford Rd, Manchester M13
9PT
Conflicts of Interest: None
Funding Sources: Grant from British Scoliosis Research
Foundation
Background Context: PVI irrigation has been proposed
as a safe and effective practice to reduce infection in
spinal surgery. However, recent evidence in multiple cell
types suggests that PVI has a deleterious effect on cellular
viability and function.
Purpose: To model spinal wound irrigation with dilute
PVI in vitro, in order to investigate the effect on osteoblast
proliferation, metabolism and bone mineralisation.
Study Design/Setting: An in vitro study on human
osteoblast cells exposed to 0.35% PVI for 3 minutes, and
analysed for proliferation rate, oxidative capacity and
mineralisation.
Patient Sample: Primary osteoblasts cultured from a
femoral head undergoing Total Hip Replacement.
Primary Cell Lines cultured from Human Osteoblast Cell
Line hFOB 1.19 (ATCC England, UK)
Outcome Measures: Cell proliferation assay: MTS
(Promega)
1. Metabolic Function: Oxygen Consumption Rate,
Extracellular Acidification Rate and Proton Production
Rate (Seahorse, Bioscience, USA)
2. Mitochondrial Function: Western Blot Immunoprobe
(GE Healthcare, UK)
3. Bone Nodule Formation: Alazarin Red (Sigma-Aldrich,
UK)
(26) 11.40-11.50
Comparison of primary and conversion surgery with
magnetically controlled growing rods in children
with early onset scoliosis
Main Author: Behrooz Akbarnia
Co Authors: Heli Keskinen, Ilkka Helenius, Pavlos
65
Panteliadis, Colin Nnadi, Kenneth Cheung, John Ferguson,
Gregory Mundis, Chrishan Thakar, Jeff Pawelek
Affiliation: San Diego Center for Spinal Disorders, La Jolla,
California, USA
Conflicts of Interest: None to declare
Funding Sources: Ellipse Technology
Background Context: It is not known how effective the
magnetically controlled growing rods (MCGR) technique is
in previously operated children.
Purpose: To compare outcomes of primary vs conversion
surgery using MCGR in children with EOS.
Study Design/Setting: Retrospective multicentre study
Patient Sample: Primary and Conversion patients with EOS
Outcome Measures: Clinical and Radiological
Methods: Data obtained for 27 primary (P) patients (mean
age 7.0 (2.4-10.7) years and 23 conversion (C) patients
(mean age 7.7 (3.6-11.0) years with one-year follow-up
Results: The mean major curve was 64 degrees (P) and 47
degrees (C) at baseline (p=0.0009) and 39.5 degrees and
39.6 degrees, respectively, at 1-year follow-up (p=0.99).
Spinal growth (T1-S1) from initial postoperative to oneyear follow-up showed no statistical difference (1.8 % (P) vs
-2.2 % (C)) p=0.09). Mean distraction of the rods achieved
was 9.3 mm in P group (SD 5.6) and 7.6 mm in C group (SD
5.8) (p=0.37). Subgroup analysis of patients with minimum
three distractions showed correction of the major curve
was better in P vs C group (40% vs. 22%, p=0.03). The mean
percentage change from baseline was larger in P vs C group
for thoracic spine (19% vs. 9.5%, p=0.14) and T1-S1 spine
(17% vs. 8.1%, p=0.08. Mean change in spinal growth in the
thoracic spine (2.2 % P vs. 1.3% C, p=0.69), and T1-S1 spine
(1.7 % P vs. 1.1 % C, p=0.77) were similar.
Conclusions: Spinal deformity can be equally controlled
after conversion from standard growing rods into MCGR,
but spinal growth from baseline is less in C patients as
compared with the P group.
(27) 11.50-12.00
Estimated X-ray exposure and additional cancer risk
during surgical treatment of scoliosis in the growing
spine
Main Author: Peter Loughenbury
Co Authors: Steph Gentles, Emma Murphy, James
Tomlinson, Robert Dunsmuir, Nigel Gummerson, Abhay
Rao, Emma Rowbotham, Peter Millner, Almas Khan
Affiliation: Leeds General Infirmary, Great George Street
Leeds LS1 3EX
Conflicts of Interest: No conflicts of interest.
Funding Sources: No funding obtained.
Background Context: Clinicians must weigh the benefits
of radiological imaging against the risks of x-ray exposure
in the diagnosis and treatment of scoliosis.
Purpose: Estimate absorbed x-ray dose and additional
cancer risk in scoliosis patients treated in our unit.
Study Design/Setting: Retrospective review of estimated
absorbed dose on the Computerised Radiology Information
System (CRIS®).
Patient Sample: Patients undergoing surgical correction of
scoliosis (age ≤25) from August 2010 to August 2015.
BRITSPINE 2016
Thursday, 7th April
Outcome Measures: Physiologic (estimated absorbed dose
- milligrays (mGy)) and functional measures (additional
cancer risk and calculated equivalent dose - millisieverts
(mSv)).
Methods: Estimated absorbed dose recorded on CRIS®.
Pedicle screws inserted using image intensification.
Equivalent dose and additional cancer risk calculated from
the National Research Council document ‘Health risks from
exposure to low levels of ionising radiation’ (2006).
Results: 271 patients identified. Mean age 15 (range 2-25).
Mean total absorbed dose was 2136mGy (SD 1700). During
treatment the mean number of spinal imaging episodes
was 8 (SD 3) with total 1884mGy exposure (SD 1609mGy).
Additional dose was provided by CT (mean 0.17 episodes),
plain chest and abdominal radiographs (mean 0.25 and
0.0625 events) and image intensification. Mean number
of image intensification episodes was 1.1 with mean
estimated exposure 180mGy (SD 238). Image intensification
accounted for 8% of the estimated absorbed dose during
treatment.
Estimated mean effective dose delivered was 20.952mSv
equating to an additional cancer risk of 0.27-0.45%.
Conclusions: Use of image intensification for pedicle screw
insertion is a minor contribution (8%) to the total patient
dose. Additional cancer risk from cumulative imaging is
small and equivalent to approximately 8 years of natural
background radiation.
(28) 12.00-12.10
Is there a correlation between MRI fat depths and
BMI measurements in the lumbar spine?
Main Author: Simon Hughes
Co Authors: Thomas Finnigan, K Hassan
Affiliation: Complex Spinal Unit, Salford Royal Foundation
Trust, Manchester
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: It is accepted that obesity (BMI
of >30) is a risk factor for post-operative complications
in lumbar spinal surgery. Whilst it is recognised that
BMI does not accurately predict body mass distribution,
the correlation between BMI and surgical site fat depth
measurements is poorly understood.
A paucity of evidence exists evaluating this relationship. We
are aware of a single paper showing an increase in surgical
site infections only with increased fat depths, as measured
on pre-op CT imaging.
Purpose: This pilot study is designed to evaluate more
clearly the correlation between BMI and fat depth
measurements on MRI imaging. If understood, further
studies on fat depth as an improved prognostic indicator
for complications in comparison to BMI, could then be
undertaken.
Study Design/Setting: Retrospective analysis of BMI and
MRI fat depth measurements on a cohort of patients listed
for single level posterior lumbar spinal surgery.
Patient Sample: 50 patients listed for single level lumbar
procedures
Outcome Measures: Physiological – Body Mass Index and
MRI fat depth measurements
BRITSPINE 2016
Methods: Electronic records of 50 patients were
retrospectively reviewed and BMI measurements noted.
Fat depth measurements were calculated on pre-op T2
weighted axial MRI scans at the level of surgery from skin to
spinous process of the upper vertebra. Regression analysis
was then performed on the data.
Results: To date our results show only a moderate
correlation on regression analysis between BMI and fat
depth
Conclusions: We postulate that MRI fat depth may be
a more important and reliable predictor for the risk of
complications in lumbar spinal surgery in comparison to
BMI.
(29) 12.10-12.20
Surgical outcome of scoliosis correction in
Duchenne muscular dystrophy using different
instrumentation constructs
Main Author: Hossein Mehdian, Queen’s Medical Centre,
Spinal Unit, Nottingham
Co Authors: A B Perez-Romera, L A Nasto, A Kapinas
Affiliation: Queen’s Medical Centre, Spinal Unit,
Nottingham
Conflicts of Interest: No conflicts of interest
Funding Sources: University of Nottingham
Background Context: With the advent newer
instrumentation systems, i.e. pedicle screw (PS), there
has been a recent trend towards its use in neuromuscular
scoliosis and DMD. However sublaminar wire (SW) is still
widely used, we therefore compared our results with these
two techniques.
Purpose: This study aims to compare SW and PS fixation in
DMD.
Study Design/Setting: Retrospective case series
Patient Sample: 43 DMD patients
Outcome Measures: Radiographic and surgical outcomes
Methods: Between 1993 and 2011, 43 patients with DMD
were treated surgically. 20 patients underwent SW fixation
(Group A), and 23 patients underwent segmental PS
fixation (Group B); instrumentation was extended from T2
to pelvis in both groups.
Results: In Group A (mean age 14.6 years, follow-up
7.6 years) the mean preoperative, postoperative and
final follow-up Cobb angles were 52.7°, 18.3° and 24.5°
respectively. The mean surgical time was 300 min with
mean blood loss of 4.1 litres. Complications included two
cases of infection, and 1 case of revision instrumentation.
In Group B (mean age 13.4 years, follow-up 6 years), the
mean preoperative, postoperative and final follow-up Cobb
angles were 45.8°, 3.6° and 4.7° respectively. The mean
surgical time was 184 minutes with mean blood loss of 3.2
litres. There was one case of prominent metalwork.
Conclusions: All constructs studied were equally effective.
SW was associated with increased operative time, blood
loss and instrumentation failure. The PS system showed
better results in terms of reduced operative time, blood
loss and maintenance of the correction. PS can provide
significant correction, less blood loss, infection, and
instrumentation failure. Hospitalisation appears to be
shorter due to a rapid recovery from surgery.
66
Thursday, 7th April
(30) 12.20-12.30
Major complications of primary versus revision
surgery in patients undergoing corrective surgery
for adult spinal deformity using three column spinal
osteotomies
Main Author: Nasir Quraishi
Co Authors: S Sabou, K Salem
Affiliation: Centre for Spinal Studies and Surgery, D Floor,
West Block, Queens Medical Centre, Derby Road, Nottingham
NG7 2UH
Conflicts of Interest: Nil
Funding Sources: Nil
Background Context: Whilst 3 column osteotomies for
adult spinal deformity are demanding, revision surgeries
encompass more challenging techniques.
Purpose: Our main purpose was to compare the
complications of posterior 3 column osteotomies in cases of
primary versus revision surgery.
Study Design/Setting: Retrospective
review
of
prospectively collected data
Patient Sample: Patients fitting the inclusion criteria (>18
years, >1 year follow up, 3 column osteotomy for sagittal/
coronal imbalance).
Outcome Measures: Complications were stratified into
major and minor categories using the classification reported
by Glassman.
Methods: A single surgeon series of posterior 3 column
osteotomies for adult spinal deformity was retrospectively
reviewed.
Results: The mean age was 61.1 years (37-77) in the Primary
group (n=20) and 60.6 years (47-76) in the Revision (n=15)
group. Diagnoses were degenerative scoliosis (18), AIS (2)
in the Primary group and fixed sagittal imbalance with (out)
adjacent level disease (12), AIS (1) and kyphoscoliosis (2)
in the Revision group. There was no significant difference
in blood loss or length of stay between groups. Clinical
outcome/ radiological correction were also similar with the
exception of greater thoracic hypokyphosis in the revision
group (p=0.04).
Complications were major (Primary (6/20 (30%)) vs. Revision
(5/15 (33%)): Instrumentation/junctional failure (4 vs. 2),
neurological deficit (0 vs. 2), deep infection (2 vs. 0)) and
minor (Primary (5/20 (25%)) vs. Revision (5/15 (33%)):
Excessive bleeding (4 vs. 4), cardiopulmonary (1 vs. 0)).
Conclusions: Three column osteotomies can achieve
good clinical and radiological outcome in primary and
revision surgeries for adult spinal corrective surgery with an
acceptable major complication rate in one third of patients.
67
Special Posters
(SP1) 11.30-11.35
Berry’s ligament and the inferior thyroid artery as
reliable anatomical landmarks for the recurrent
laryngeal nerve (RLN) - a fresh cadaveric study
relevant to the cervical spine
Main Author: Ali Rajabian
Co Authors: Michael Walsh, Nasir A Quraishi
Affiliation: The Centre for Spinal Studies and Surgery,
Queen’s Medical Centre, Nottingham NG7 2UH
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Whilst most cadaveric studies of the
Recurrent Laryngeal Nerve (RLN) have focused on course
variations as a suitable guide for Right versus Left RLN,
they have mostly been done on preserved (fixed) cadavers
which renders the RLN immobile.
Purpose: Our aim was to perform anterior cervical
exposures from C2 to T2/3 with particular attention to the
course of the RLN on right and left sided exposures in fresh
cadaveric specimens. In addition, we aimed to expose the
entire course of the RLN. Finally, we wanted to show the
position of the RLN in relation to the trachea-oesophageal
groove, inferior thyroid artery and Berry’s ligament.
Study Design/Setting: Fresh Cadaveric study
Patient Sample: Eight fresh cadavers
Outcome Measures: High quality photographs of
Cadaveric study
Methods: Eight fresh cadavers had extensive layer by layer
dissections performed by 2 surgeons (one of whom has
extensive experience as an anatomy demonstrator and
dissector). The RLNs were exposed in their entire length and
relationship to different landmarks recorded. Photographs
were taken at each stage of the exposure.
Results: In all specimens, we were able to demonstrate
the entire course of both RLNs from origin to insertion.
The RLNs were consistently associated with the inferior
thyroid artery and Berry’s ligament bilaterally with the RLNs
passing at almost perpendicular to these structures.
Conclusions: The near horizontal direction of the Berry’s
Ligament in the cervical tissue planes exposed during
anterior cervical exposures enables the surgeon to reliably
identify the expected position of RLN at its medial end and
hence avoid it prior to visual observation of the nerve on
either side.
We found that the most reliable anatomical landmark
bilaterally for the RLN was the inferior thyroid artery and
Berry’s ligament both of which would be encountered in
anterior surgical exposure prior to the nerve itself.
We believe that this will help spinal surgeons refine their
surgical technique to identify this nerve where necessary
and thus reduce the incidence of iatrogenic injury.
BRITSPINE 2016
Thursday, 7th April
(SP2) 11.35-11.40
(SP3) 11.40-11.45
Right versus left sided exposures of the recurrent
laryngeal nerve (RLN) and its branches - a fresh
cadaveric study relevant to the cervical spine
Comparing patient outcome measures in a cohort
of patients who underwent anterior cervical
discectomy and fusion (ACDF) versus cage-plate
ACDF
Main Author: Ali Rajabian
Co Authors: Michael Walsh, Nasir A Quraishi
Affiliation: The Centre for Spinal Studies and Surgery,
Queen’s Medical Centre, Nottingham NG7 2UH
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: The higher vulnerability of RLN
in anterior approach to the cervical spine on the right
versus left sides is the subject of ongoing debate. Whilst
most cadaveric studies have focused on in situ variations
in course and local structural relations of the RLN as a
suitable guide, they have mostly been done in preserved
(fixed) cadavers or without relevance to the needs of spinal
exposure.
Purpose: Our aim was to perform surgically relevant
exposures of the anterior cervical spine with particular
attention to observing the potential vulnerabilities of the
RLN on right and left side in fresh cadaveric specimens. In
addition, we aimed to explore its branches.
Study Design/Setting: Fresh Cadaveric study
Patient Sample: Eight fresh cadavers
Outcome Measures: High quality photographs of
Cadaveric study
Methods: 12 cadavers had extensive layer by layer
dissections by 2 surgeons (one with extensive experience
as anatomy dissector). The RLNs and its branches
were exposed in their entire length and explored for
vulnerability. (Each stage was photographed)
Results: In all specimens, we demonstrated that right sided
approach clearly causes undue stretch of the nerve and its
branches particularly below C5 (photographed). The left
side provided a good exposure without undue traction on
the nerve. However, the terminal oesophageal branches of
the nerve were especially vulnerable to this stretch or direct
pressure on the left side.
Conclusions: Traction neuropraxia of the upper
oesophageal branches of the RLN nerve may provide an
alternative explanation for the transient post-op dysphagia
(up to 60%). The laryngeal supply of the RLN benefits from
Galen’s anastomotic nerve supply of SLN (Ansa of Galen)
and hence the neuropraxia of the nerve is less frequently
symptomatic.
Below C5, the left sided anterior cervical approach permits
a wider access to the entire anterior cervical spine with less
risk to the RLN. Neuropraxia induced on the oesophageal
branches (directly by retractors or indirectly by traction)
could provide a possible explanation for transient post-op
dysphagia. We believe that this will help spinal surgeons
to refine their surgical technique and thus reduce the
incidence of iatrogenic injury.
BRITSPINE 2016
Main Author: Shrijit Panikkar
Co Authors: Iain McLaughlin-Symon, Gagan Sethi, Irfan
Siddique
Affiliation: Spinal Unit, Salford Royal NHS Foundation Trust,
Stott Lane, Manchester M6 8HD
Conflicts of Interest: No Conflicts of Interest
Funding Sources: No funding obtained
Background Context: Most studies tend to favour better
fusion rates with anterior cervical discectomy and fusion
with plating against without. It is unclear whether this
translates to better patient outcome.
Purpose: Comparing patient outcomes of standalone cage
anterior cervical discectomy and fusion (ACDF) versus cageplate ACDF.
Study Design/Setting: Retrospective study of
prospectively collected registry data.
Patient Sample: Consecutive patients undergoing ACDF
over a four year period at a single centre.
Outcome Measures: Registry collected surgical
details, global effectiveness score and Core Outcome
Multidimensional Index (COMI) scores pre-operatively and
at one year post-op.
Methods: Statistical analysis of the outcome measures of
the two groups were undertaken using the t-test and the
Chi test.
Results: After exclusion of missing data pre-operative,
surgical and one year postoperative data was available for
212 patients who underwent stand-alone cage ACDF and
34 patients who underwent cage-plate ACDF. A similar
percentage [24(71.59%) and 152(71.03%)] of patients in
each group were satisfied with the outcome of the surgery.
Both groups had similar global outcome, improvement in
COMI scores and perioperative complication rates.
Conclusions: There was no statistical difference in hospital
stay, perioperative complications and 1 year clinical
outcomes between patients undergoing ACDF with standalone cage versus ACDF with cage and plate.
(SP4) 11.45-11.50
Missed cervical spine injuries - a national survey of
the practice of evaluation of the cervical spine in
obtunded patients
Main Author: Simon Craxford
Co Authors: Edward Bayley, Michael Walsh, Jonathan Clamp,
Bronek Boszczyk, Oliver Stokes
Affiliation: Royal Derby Hospital
Conflicts of Interest: No conflicts of interests to declare
Funding Sources: N/A
Background Context: Identifying cervical spine injuries (CSI)
in obtunded trauma patients provides a particular diagnostic
challenge. Several clearance protocols have been developed
in an attempt to standardise care and reduce missed injuries.
68
Thursday, 7th April
The implementation of and adherence to these protocols in
English hospitals is unknown. Furthermore, it is not known
whether these protocols have eliminated missed CSIs.
Purpose: To establish current cervical spine clearance
practice in England.
Study Design/Setting: A national survey of English
hospitals that manage adult trauma patients.
Patient Sample:
Outcome Measures:
Methods: All hospitals in England with an Emergency
Department were surveyed about their cervical spine
clearance protocols. All 22 Major Trauma Centres (MTCs) and
141 out of 156 non-MTCs responded (response rate 91.5%).
Results: Written guidelines were used in 85% of responding
hospitals. Computed Tomography (CT) scanning was
the first line investigation in 75%. A normal CT scan was
sufficient to clear the cervical spine in 45%, however, 25%
would continue precautions until the patient regained full
consciousness. A Magnetic Resonance Imaging (MRI) was
performed in all obtunded patients with potential CSI in
9% of the units surveyed. Significant variations existed in
the grade and speciality of the clinician who had ultimate
responsibility for deciding when to discontinue spinal
precautions. Eighteen percent reported at least one missed
CSI following discontinuation of spinal precautions within
the last 5 years. Only 52% had a formal mechanism for
reviewing missed injuries.
Conclusions: Significant variations in protocols and
practices for cervical spine clearance exist within acute
hospitals in England. The establishment of trauma networks
should be taken as an opportunity to further standardise
trauma care.
(SP5) 11.50-11.55
RAPPER II - Robot Assisted PhysiotheraPy Exercises
WITH REX powered walking aid in patients with
spinal cord injury
Main Author: Nick Birch
Co Authors: Jon Graham, Tom Priestley
Affiliation: Consultant Spinal Specialist, Chris Moody
Rehabilitation Centre, Moulton, Northants
Conflicts of Interest: Nick Birch is a stockholder in REX
Bionics PLC (<£15,000) and paid consultant (<£13,000 pa)
for REX Bionics plc; Jon Graham is a paid consultant for REX
Bionics plc (<£15,000 pa); Tom Priestley is an employee of
REX Bionics plc
Funding Sources: The study is funded by REX Bionics PLC
Background Context: Patients with spinal cord injury (SCI)
benefit from standing and walking. This can be enhanced
if they can also exercise when upright. With assisted
ambulation, in a REX, upright function allows wheelchair
users to regain some of the independence lost through their
SCI.
Purpose: Investigate the safety and utility of physiotherapy
in people who use the REX assisted walking device
Study
Design/Setting:
Prospective,
multi-centre
(international), open label, single arm, registry study
supervised by an Independent Clinical Research Organisation
(clinicaltrials.gov: NCT02417532).
Patient Sample: 100 people with SCI.
69
Outcome Measures: Primary: Completion of transfer;
completion of shoulder and trunk exercises; serious adverse
events (AE). Secondary: Time of transfer; autonomous
control; Timed Up and Go (TUG) Test; completion of
satisfaction questionnaire.
Methods: Observation of participants involved in the tests
described by the Primary and Secondary outcomes
Results: Interim analysis of the first 20 patients. 19 could
transfer (mean time 7 min 19 sec), 10 without help or with
one assistant. Seven with two and one needed a hoist. 18
completed the exercise program. There were no AEs. 19
completed a TUG Test (mean 5 min 12 sec); 17 with just one
helper and all achieved autonomous control of the robot.
User feedback showed very positive responses for device
acceptability.
Conclusions: This study shows that REX allows standing
exercise in patients with SCI to be performed safely. This
is unique amongst powered assisted ambulation devices.
Users were able to achieve control of the REX and use it to
move, quickly and easily and there was a high overall level of
acceptability of the device.
(SP6) 11.55-12.00
Long term outcome of paediatric spinal cord injury
Main Author: Naveen Kumar Co Authors: Richa Kulshrestha, J R Chowdhury, W El-Masri,
A E Osman
Affiliation: Robert Jones and Agnes Hunt Orthopaedic
Hospital, Oswestry
Conflicts of Interest: None
Funding Sources: None
Background Context: Spinal cord injuries (SCIs) are
relatively uncommon in children and evidence about longterm outcomes is limited.
Purpose: To describe long-term outcomes of SCI in
children.
Study Design/Setting: Regional Spinal Injuries Centre
Patient Sample: Cross sectional review of all 69 children
with traumatic SCI with minimum of 10 years follow-up.
Outcome Measures: Functional independence and SCI
related complications.
Methods: Retrospective review of clinical records of
all children injured between 1977-1999. Complications
studied were renal, bowel, musculoskeletal, skin and
mortality. Complications studied were renal, bowel,
musculoskeletal, skin and mortality. Demographic and
injury-related factors included age at injury, aetiology, level
of injury, neurological level, treatment and social outcomes
of employment and driving were recorded.
Results: Between discharge and the most recent review
there was a 17% (12/69) increase in self-intermittent
catheterization and 11.6% (8/69) increase in suprapubic
catheters. One patient developed renal failure and one had
a nephrectomy. Six patients had urinary diversion / stoma.
88% (61/69) were on bowel program however 3 patients
had colostomy. Of the patients without preceding spinal
pathology 29% (17/59) developed scoliosis. Only 29%
(5/17) of these required corrective surgery. 26% (18/69)
had pressure ulcers. Of these 3 had stage 3 ulceration over
the ischium and left lower leg. 6 (11%) had confirmed
BRITSPINE 2016
Thursday, 7th April
post-traumatic syrinx. 75% (52/69) were independent with
activities of daily living. 46% (32/69) could drive and 39%
(27/69) were in employment or higher education.
Conclusions: Our study demonstrates the manifestation
of SCI related complications of in those injured as a child
and demonstrates good long term functional outcome
after holistic management including regular follow up and
monitoring.
(SP7) 12.00-12.05
C2 odontoid process fractures in the elderly:
observations on the natural history of nonoperative management
Main Author: Andreas K Demetriades
Co Authors: Himanshu Shekhar, Patrick Statham
Affiliation: Department of Neurosurgery, Western General
Hospital, Edinburgh
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Management of odontoid fractures
in the elderly remains controversial.
Purpose: Our objective was to study the outcomes of nonoperative management in patients unsuitable for surgery.
Study Design/Setting: Design: Retrospective analysis of a
prospectively collected cohort over a 2 year period.
Setting: patients with a C2 odontoid process fracture seen in
the spinal fracture clinic.
Patient Sample: 34
Outcome Measures: Physiologic outcomes measures
assessed on imaging: osseous fusion, stable non-union and
unstable non-union rates.
Methods: Inclusion criteria: age >70 years.
Exclusion criteria: initial surgical management; noncompliance with collar; incomplete follow-up. Case-notes
and radiology reviewed with patient demographics, clinical
status and fracture characteristics.
Results: 34 patients fulfilled inclusion criteria.
Male: female=9:25. Mean age 83 (72-94).
Classification: 1 type I, 24 type II and 9 type III fractures.
The overall osseous fusion rate at an average of 6 months
c-spine immobilisation was 30%. Healing rates were: 0% for
type I; 8% for type II; 89% for type III.
Non-union rate was 71%. Of this, about half (38% overall)
had no abnormal movement at the fracture site on dynamic
x-rays at an average of 7 months. The remaining half ie, those
without bony fusion or stable non-union (32% overall), were
offered lifelong collar immobilisation due to comorbidities
and patient choice. In type II fractures, displacement >4mm
was observed in more than half of the patients with unstable
non-union.
Conclusions: In the elderly, conservative management of the
odontoid process fracture is a practical option. The majority
of patients have a good clinical outcome, with overall rates
of 30% union and 38% stable non-union, as 54% (13/24) of
non-union cases were stable on dynamic X-rays.
Features which would indicate higher chances of union are:
Type III fractures and, in type II, optimal fracture alignment
(displacement ≤4mm).
BRITSPINE 2016
In unstable non-union (32% of cohort), the question remains
whether a lifelong collar is appropriate or if the benefits of
surgical intervention outweigh the risks.
(SP8) 12.05-12.10
Occipital condyle fractures – the need for
immobilisation?
Main Author: Syed Aftab
Co Authors: Omar Musbahi, Senthil Muthian, Saman Zehra,
Arun Ranganathan, Jonathan Bull, Suresh Pushpananthan,
Alexander Montgomery
Affiliation: Royal London Hospital, Barts Health NHS Trust,
Whitechapel, London E1 4BB
Conflicts of Interest: None
Funding Sources: None
Background Context: Occipital Condyle fractures are
uncommon injuries often associated with high energy
trauma. The reported mortality rate is 11% (dislocation is
often fatal) and is often associated with other injuries.
Purpose: We report our series of 63 consecutive cases of
occipital condyle fractures, their management and outcome
Study Design/Setting: Retrospective cohort study
Patient Sample: Patients presenting with Occipital Condyle
Fracture
Outcome Measures: Management method and adverse
effects.
Methods: A retrospective search of 1758 patients at a Major
Trauma Centre over 3 years on our spinal trauma database
was performed. Any patient with a CT cervical spine with
occipital condyle fracture reported was identified. Images
were reviewed and the fractures were classified. Patient
history and documentation was reviewed to glean further
details
Results: Average age 32 years. Anderson and Montesano
classification grade I 61%, II 24%, III 14%. Isolated OC
fracture: 21%. Associated with other c-spine injury: 15%,
base of skull # 25%, abdominal visceral + other injury: 15%.
Mortality rate: 22%. Surgical fixation: 9%. Hard collar: 50%.
No immobilisation: 41%, for isolated injury
Conclusions: The majority of patients present with type I or
II fractures. There is a high mortality rate, though this is often
due to other injuries. Most are managed with a hard collar.
However, those patients treated without any immobilisation
did not exhibit any adverse effects at one to three year
follow up. It is concluded that isolated undisplaced occipital
condyle fractures may be managed safely without any need
for immobilization.
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Thursday, 7th April
(SP9) 12.10-12.15
Comparison of EVICEL® and Tisseel use for dural
repair in spinal surgery
Main Author: Myron Ciapryna
Co Authors: Fady Sedra, Adrian Casey, Kia Rezajooi
Affiliation: Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex HA7 4LP
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Watertight closure of the dura in cases
of intradural surgery is considered important in reducing
postoperative morbidity. Primary closure intraoperatively
is via dural suture repair with adjunct clotting agents
commonly used to aid repair and reduce postoperative
CSF leak. Currently there is little evidence available on the
comparative efficacy of different clotting agents for this use.
Purpose: To ascertain the relative efficacy of EVICEL®
compared to TISSEEL for dural repair in spinal surgery.
Study Design/Setting: Non randomised retrospective and
prospective case controlled study
Patient Sample: All patients undergoing spinal tumour
excision surgery and complex revision surgery where
dural tear and repair was anticipated under the care of 2
neurosurgeons at the Royal National Orthopaedic Hospital.
Outcome Measures: Postoperative CSF leak
Re-operation rate (for CSF leak)
Wound healing / Wound breakdown
Pseudomeningocele formation
Length of stay
Methods: Retrospective analysis of outcomes of dural repair
for 20 patients where Tisseel was solely used was conducted.
Subsequently all patients requiring dural repair for the same
indication as the previously analysed group were treated
solely with Evicel and outcomes compared.
Results: EVICEL® Sample Size: 19 (M 10; F9) Tisseel Sample
Size: 20 (M 11; F9).A statistically significant reduction in post
op CSF leak was observed in the EVICEL® group (p=0.02)
with 0 cases of CSF leak in the EVICEL® cohort vs 5 cases
in the Tisseel cohort. There were no statistically significant
differences in all other outcomes between the two groups.
Conclusions: Evicel use for dural repair in spinal surgery
resulted in a significant reduction in post op CSF leak.
(SP10) 12.15-12.20
Surgery for spinal metastases is cost effective:
calculation of cost per QALY in UK patients
Main Author: Isobel Turner
Co Authors: Joanne Kennedy, David Choi
Affiliation: National Hospital for Neurology and
Neurosurgery, Queen Square, London WC1N 3BG
Conflicts of Interest: No conflicts of interest
Funding Sources: David Choi receives research funding
from DePuy Synthes
Background Context: There is currently a tough financial
climate in the NHS due to limited resource. Surgical
management of symptomatic spinal metastases is
71
common; however, there is limited data demonstrating cost
effectiveness.
Purpose: To calculate cost per QALY for patients undergoing
surgery for spinal metastases
Study Design/Setting: A prospective, single-centre cohort
study. Costs and QALYs for a matched non-surgical group
were modelled for comparison.
Patient Sample: Consecutive patients presenting for
surgery for symptomatic spinal metastases.
Outcome Measures: Demographic information was
collected at baseline. EQ-5D and Frankel grade were
collected pre-operatively, post-operatively, at 3, 6, 12
months and yearly until death. The tariff allocated for each
patient admission was retrieved from the hospital’s financial
database.
Methods: Hospital tariffs were summed, by patient, for
all admissions relating to neurosurgical treatment of
symptomatic spinal metastases. Homecare tariffs were
based on the NICE economic guidance for MSCCs. QALYs
from surgery until death were calculated from the EQ5D
index. Non-surgical group: Patients were allocated hospital
tariffs representing radiotherapy treatment. Homecare tariffs
were modelled using a shorter lifespan and ambulation, in
line with the study by Patchell (2005). QALYs assumed no
improvement following intervention and reduced survival.
Results: 88 patients were recruited. The median cost of
surgery and community care was £33,518; radiotherapy and
community care, £30,237. Median QALYs post-surgery were
0.20, and with no surgery were 0.17. The cost per additional
QALY gained by surgery was £531.
Conclusions: Whilst surgical costs of managing spinal
metastases remain high, longer ambulation results in
reduced community costs. Our results show that surgery for
symptomatic spinal metastases is cost effective.
(SP11) 12.20-12.25
Coccygodynia – transsacrococcygeal ganglion impar
block
Main Author: Kiran Koneti
Co Authors: Palaniappan Lakshmanan, Sashi G Roysam,
Tony Cross, Balaji Purushothaman
Affiliation: City Hospitals Sunderland NHS Foundation Trust
Conflicts of Interest: None
Funding Sources: N/A
Background Context: Coccydynia (Coccygodynia) is a
relatively uncommon, debilitating pain condition affecting
predominantly females with significant impairment of
quality of life with unpredictable surgical results.
Purpose: The physical and pharmacological treatment
options sometimes fall short of offering expected pain
relief and interventional treatments might be needed.
Even though, surgical coccygectomy has been successful
in offering pain relief, due to multitude of causes some
patients continue to experience pain in spite of successful
surgery. One of the proposed mechanisms of Coccydynia is
sympathetically medicated pain through sensitisation of the
ganglion impar. The non-surgical interventions like ganglion
impar block, either single shot or sometimes repeated
procedures might provide significant pain relief.
Study Design/Setting:
BRITSPINE 2016
Thursday, 7th April
Patient Sample:
Outcome Measures: VAS reduction, Analgesic reduction,
Quality of life improvement
Methods: 7 Patients with Coccydynia, who preferred
non-surgical treatment were offered ganglion impar
block for pain relief. The procedure was performed as day
case, avoiding GA, using trassacrococcygeal approach of
the ganglion impar using 22G/ 100mm curved cannula
under strict aseptic precautions. After lateral fluoroscopic
confirmation of needle tip position just anterior to the
articulation and contrast confirmation of the spread, up to
10 ml 0.5% L-Bupivacaine with 40mg Triamcinolone was
injected after negative aspiration.
Results: VAS score reduced by 60-75% in all patients lasting
more than 6 months. The analgesic requirement fell by more
than 50 % with improvement in quality of life.
Conclusions: Ganglion Impar block offers another mode
of non-surgical pain relief for Coccydynia. The technique
offers advantages with avoidance of GA and less chances
of damage to the surrounding viscera, which is a significant
risk with other conventional approaches. This route also
paves the way for neuro ablative techniques for extending
the duration of pain relief.
(SP12) 12.25-12.30
Spinal meningiomata: what lessons can be learned
after long term (>10 years) follow up
Main Author: Andreas K Demetriades
Co Authors: Jonathan Shapey, Safa Al-Sarraj, Ranj Bhangoo,
Nick Thomas, Richard Gullan
Affiliation: Western General Hospital, Edinburgh; King’s
College Hospital London
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding received
Background Context: Spinal meningiomata are rare.
Recurrence rates and length of follow-up have clinical and
cost-effectiveness implications.
Purpose: To assess recurrence rates and establish a
reasonable length of follow-up
To update data from the same study from 5 years ago.
Study Design/Setting: >10 year retrospective review in a
tertiary referral centre
Patient Sample: 31
Outcome Measures: Radiological recurrence and Clinical
significance
Methods: Cases treated 1999-2003, ensuring >10 year
follow-up, analysed for recurrence regarding location,
resection, histology.
Exclusion criteria included incomplete records; imprecise
surgical information; multiple meningiomata.
Results: Demographics: n= 31; M : F= 2 : 29, Mean age 63 (2288).
Length of follow up: mean 156 months (138-192).
Location: Cervical: Cervicothoracic: Thoracic: Thoracolumbar:
Lumbar: Lumbosacral: Sacral= 5:3:21:0:1:1:0
Primary vs revision operation: Two cases (6.5%-2/31) had
prior surgery.
BRITSPINE 2016
Degree of resection: 79% cases with Simpson grade 1/2
resection; 21% Simpson grade 3/4.
Histology: 93.5% (29/31) were WHO Grade I, the
remainder being atypical (Grade II). Only 1 patient had
Neurofibromatosis, with Grade I histology and not recurring.
Recurrence: overall recurrence rate was 6.5% (2/31), with
3.4% (1/29) in primary presentations and 50% (1/2) in reoperated patients. The case that recurred for the second time,
at 1 year, was a grade II lumbo-sacral Simpson 4 resection
that had further radiosurgery. The other recurrence, at 6
years, was a WHO I Simpson 2 cervical meningioma. There
were no further recurrences.
Conclusions: 1. We confirm regrowth relates to Extent of
resection and Grade of tumour.
2. The vast majority do not recur; continued surveillance is
potentially costly, unnecessary and may provoke long-term
anxiety.
3. However, in WHO Grade II or higher tumours regrowth/
recurrence is likely.
12.30-13.00
Towards Guidelines in Adult Spine
Deformity Surgery
Sashin Ahuja, Robert Crawford, Joost van
Middendorp
With societal improvements in health and increased life
expectancy has come increasing demand for treatment
of degenerative musculo-skeletal disease. Adult spine
deformity (ASD) is one particularly challenging aspect of
this. Some patients who are treated for apparently simple
problems, such as a single level degenerative
spondylolisthesis, may subsequently develop severe ASD.
This may cause problems to spine surgeons who do not
normally deal with spinal deformity. As of yet there are no guiding documents reflecting on the
efficacy, safety and cost-benefits of various ASD treatments.
The British Scoliosis Society (BSS), therefore, decided to draw
up evidence-based guidelines for the treatment of ASD. To
this end a steering group was formed and a Scientific
Adviser and Data Manager were appointed. Six scoping
areas within the subject of ASD were defined namely,
patient selection, non-operative management, preoperative assessment, surgical options, complications and
cost-effectiveness. Two or three members of the steering
group were assigned to each area and drafted their 10
most relevant questions. An extensive systematic search of
contemporary literature was initiated. Data from included
references are currently being abstracted into a spreadsheet.
This groundwork will enable the steering group to postulate
recommendations according to GRADE methodology and
subsequently reach consensus using the Delphi technique.
Patients with ASD may present to spinal deformity
surgeons, low back surgeons and pain specialists. Therefore,
the BSS steering group will welcome input from members of
all three societies.
72
Thursday, 7th April
Top ten research priorities for spinal cord
injury: The methodology and results of a
British priority setting partnership
Joost van Middendorp
Authors (order of listing):
1. Dr Joost J. van Middendorp1,2,3, MD PhD MClinEpid;
jvanmiddendorp@gmail.com*
2. Dr Harriet C. Allison1,2, PhD; harriet.allison@
buckshealthcare.nhs.uk
3. Mr Sashin Ahuja4; sashinahuja@doctors.org.uk
4. Mr Dave Bracher5; davebracher1@gmail.com
5. Ms Christa Dyson5; christa@focusforwards.com
6. Prof Jeremy Fairbank6, MA, MD, FRCS; jeremy.fairbank@
ndorms.ox.ac.uk
7. Dr Angela Gall7; Angela.Gall@rnoh.nhs.uk
8. Ms Ann Glover8; annie.cesukcharity@gmail.com
9. Mr Lew Gray9; lew.gray@myelitis.org.uk
10.Prof Wagih El Masri10; Bellstonehse@btinternet.com
11.Mr Andrew Uttridge11; andrew.uttridge@rstrust.com
12. Ms Katherine Cowan12, MA; katherine@katherinecowan.net
1. National Spinal Injuries Centre, Stoke Mandeville
Hospital, Buckinghamshire NHS Trust, Aylesbury, UK
2. Stoke Mandeville Spinal Research, National Spinal
Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
3. Harris Manchester College, University of Oxford,
Oxford, UK
4. Department of Spine Surgery, University Hospital of
Wales, Cardiff, Wales
5. Spinal Injuries Association, Milton Keynes, UK
6. Nuffield Department of Orthopaedics, Rheumatology
and Musculoskeletal Sciences, University of Oxford,
Oxford, UK
7. London Spinal Cord Injury Centre, Stanmore, UK
8. Cauda Equina Syndrome UK Charity, Leicester, UK
9. Transverse Myelitis Society, Brentford, UK
10.Keele University, Keele, UK
11.The Rooprai Spinal Trust, Hertford, UK
12.James Lind Alliance, NIHR Evaluation Trials and Studies
Coordinating Centre, Southampton, UK
*Presenting author
This project was supported by funding provided by the
NIHR Oxford Biomedical Research Centre. This project was
undertaken by the Stoke Mandeville Spinal Research, a
research charity. The work presented here represents the
views of the authors and not necessarily those of the funding
bodies. The authors declare that they have no conflicts of
interest.
Abstract
With an aim to identify a top ten list of priorities for future
research into spinal cord injury, the British Spinal Cord
73
Injury Priority Setting Partnership was established in 2013
and completed in 2014. Stakeholders included consumer
organisations, healthcare professional societies and
caregivers. This partnership involved the following four
key stages: I) gathering of research questions, II) checking
of existing research evidence, III) interim prioritisation and
IV) a final consensus meeting to reach agreement on the
top ten research priorities. Adult individuals with spinal
cord dysfunction due to trauma or non-traumatic causes,
including transverse myelitis, and individuals with a cauda
equina syndrome (henceforth grouped and referred to
as SCI) were invited to participate in this priority setting
partnership.
We collected 784 questions from 403 survey respondents
(290 individuals with SCI) which, after merging duplicate
questions and checking systematic reviews for evidence,
were reduced to 109 unique unanswered research questions.
A total of 293 people (211 individuals with SCI) participated
in the interim prioritisation process, leading to the
identification of 25 priorities. At a final consensus meeting,
a representative group of individuals with SCI, caregivers,
and health professionals agreed on their top ten research
priorities which will presented by the principal investigator.
Following a comprehensive, rigorous, and inclusive process,
with participation from individuals with SCI, caregivers,
and health professionals, the SCI research agenda has been
defined by people to whom it matters most and should
inform the scope and future activities of funders and
researchers for the years to come.
12.30-13.00
Reports from UKSSB Society for Back
Pain Research (SBPR) Travelling Fellows
(1)A European collaboration on a project for
antibiotics for LBP
Dr Majid Artus
NIHR Clinical Trials Fellow (Arthritis Research UK
Primary Care Centre, Institute for Primary Care and
Health Sciences, David Weatherall Building, Keele
University). Sites visited: Oslo/Norway; Bergen/
Norway; Odense/Denmark
Date of visits: 7-13 April 2015
Abstract visit report
I applied for this award as I was developing, with a team from
Keele University and collaborating with leading research units
in Oxford, Birmingham, Southampton, Bristol and Bangor, a
proposal for a multicentre randomised controlled trial to test
the effectiveness of antibiotic Doxycycline for severe chronic
low back pain (LBP) in primary care. This followed a highly
cited small secondary care Danish trial in this area (Albert
et al 2013) that showed large benefit from treating patients
with severe chronic LBP and Modic changes on MRI scan
with co-amoxiclav capsules (500mg/125mg) compared with
placebo, over 100 days period. The aim of our proposed trial
was to provide a clear and robust evidence base to confirm
or refute the evidence around the effectiveness of antibiotics
for chronic LBP and whether Modic changes are indeed the
phenotype for patient selection for this treatment. At the time
of the application, we were aware of a number of European
BRITSPINE 2016
Thursday, 7th April
teams pursuing research in this area including at least one
secondary care clinical trial that had been funded in Norway,
to replicate the Danish trial.
The overall aims of the travel was to meet the European teams
and learn from them as they develop and deliver projects on
antibiotics and LBP, to help develop and refine a high quality
funding application and detailed trial protocol for the UK trial,
ready to submit to funders including Arthritis Research UK
and the NIHR HTA programme. A second linked aim was to
establish strong channels of communication and explore the
potential for future European collaboration in this area. My
specific objectives were:
a) To share the details of our projects with the Norwegian
trial team to identify ways to ensure that our respective trials
collect key data in similar ways that will facilitate potential
future pooling of data in meta-analyses.
b) To identify the outcome measures used in European trials
in this field and understand their rationale. This includes a
number of outcome measures that have been suggested by
various teams, including Modic changes on MRI scans, serum
biomarkers and clinical features.
c) To discuss with the well-known academic MRI team in
Bergen/Norway the latest advances in MRI studies of the
spine and their innovative approaches with a specific focus
on Modic changes. Specifically, as that team was part of the
Norwegian replication trial, to share our MRI protocols for
the respective trials. This is one of the crucial and challenging
areas because of the variation in identifying these changes
depending on the protocol and types of MRI used.
My travel was a one-week whistle-tour summarised as follows:
Tuesday and Wednesday 7-8 April: Oslo University Hospital
Ullevål meetings the Norwegian team lead by John Anker
Schwartz (CI of the Norwegian trial), Kjersti Storheim (PI) and
other team members.
Friday 10 April: Bergen Haukeland University Hospital
meeting the MRI team lead by Ansgar Espeland.
Monday 13 April: Odense/Denmark meeting Hanne Albert
and Joan Solgaard Sorensen, from the Danish trial team.
The visits were highly successful in achieving my objectives
and strong collaborative links have been established.
Albert HB, Sorensen JS, Christensen BS, Manniche C. Antibiotic
treatment in patients with chronic low back pain and
vertebral bone edema (Modic type 1 changes): a double-blind
randomized clinical controlled trial of efficacy. Eur Spine J 2013;
22:697–707
manage to stay at work with chronic musculoskeletal pain
– an under-researched population in this field. This work
received the President’s Award at the Society’s 2014 Annual
Conference in Dublin, Ireland, and ‘Best Poster’ Prize at the
2014 International Scientific Conference on Work Disability
Prevention & Integration in Toronto, Canada.
Our findings indicate that significant others also need
information and advice in order to attenuate any maladaptive
pain appraisals and to support patient self-management
and work participation. Therefore, we propose to explore
how existing evidence-based patient educational material
(eg, The Back Book, Tackling Musculoskeletal Problems: a
guide for clinic and workplace) can be expanded to include
information and advice for significant others, with the aim
of supporting collaborative self-management. Preliminary
studies have shown that collaborative self-management can
improve patient outcomes in several public health domains,
but it has yet to be applied to chronic musculoskeletal pain.
This area of research would make a significant contribution
to the under-represented ‘social’ dimension of the
biopsychosocial model currently applied to the treatment
and rehabilitation of chronic musculoskeletal pain, and
provide further information on how ‘significant others’ can
be usefully involved in pain management and vocational
rehabilitation.
(2) Assisting ‘significant others’ in the collaborative
self-management of pain
An online survey using the Extended Scope Physiotherapy
Professional Network (ESPPN) database enquired about roles
and responsibilities, scope of practice and salary banding.
This resulted in visits to 5 UK spinal centres, providing the
opportunity to observe and discuss practice within the
Multi- Disciplinary Spinal Team:
Dr Serena Bartys
Principal Research Fellow, University of Huddersfield
Research presented to the Society for Back Pain Research
(McCluskey et al, 2011; 2012 & 2014) has revealed that
‘significant others’ (spouses/partners/relatives) may have an
important influence on recovery and return to work for those
with chronic musculoskeletal pain. This novel, exploratory
work has indicated that significant others can either help or
hinder the recovery and return-to-work process depending
on their own beliefs and responses. This research has been
further developed in collaboration with the University of
Groningen in the Netherlands, and has focused on the
supportive influences of the significant others of those who
BRITSPINE 2016
(3)An investigation into roles of Spinal Extended
Scope Physiotherapy Practitioners (ESP) within the
Acute NHS setting
Jill Billington/Catherine Kelsall
Lancashire Teaching Hospitals NHS Trust (LTHTR)
Background
ESPs and Consultant Physiotherapists have significantly
extended their terms of clinical practice over recent years.
The purpose of this investigation was to explore and share
models of good practice undertaken by Spinal Physiotherapy
Practitioners within acute NHS settings in 5 key areas:
1.Deformity
2. Spinal injections
3. Pre and post-operative services
4. Provision of rapid access pathways for acute pathology
5.Research
Methods
• Royal National Orthopaedic Hospital
• Nuffield Orthopaedic Centre Oxford
• West Hertfordshire Hospitals NHS Trust Hemel Hempstead
• The Royal Devon and Exeter NHS Foundation Trust Queen
Elizabeth Orthopaedic Unit
• The Royal Orthopaedic NHS Foundation Trust Birmingham
74
Thursday, 7th April
Results
Deformity services were provided at 4 tertiary centres. At
one, the ESP was a key part of the MDT decision making
process when listing for complex adult deformity correction,
alongside collating and interpreting the pre- and postoperative data. No other centres involved ESPs in listing for
deformity.
Spinal injections were undertaken by ESPs in 2 centres. One
centre being nationally respected for their innovative ESP
injection service, providing competencies for other centres
to follow their lead. Both centres had provided in-house
training to their ESPs and all demonstrated high levels of
technical skill and competency, being fully supported by
surgical colleagues.
Each spinal centre provided a different review process for
pre- and post-operatively patients. ESPs were observed
directly listing patients for surgery and discussing risk/
benefit. Some ESPs were involved in pre-operative
education and post-operative follow-up. Provision for the
assessment of the urgent spinal patient was provided by
spinal on-call teams without direct involvement from ESPs.
However, 3 visits observed ESPs undertaking daily triage
of spinal referrals, signposting urgent patients to the most
appropriate pathway.
All the ESPs we visited were involved in research and audit
in some capacity, including involvement in national research
and development projects, research publication and
presentations at national conferences.
Conclusion
ESPs working within UK spinal centres demonstrate high
levels of clinical skill, they undertake varied and extensive
responsibilities within the clinical setting and contribute to
high quality, nationally recognised spinal services. The spinal
surgeons value the ESPs within their teams, particularly
acknowledging the consistency and continuity delivered by
the ESPs within their spinal services. The travelling bursary
has provided a valuable insight into how other departments
work, showing the varied roles of colleagues within similar
spinal services and demonstrated how other MDTs integrate
together. This opportunity to network with other spinal
practitioners has enhanced our own personal professional
development and identified areas of practice and inspiration
to enhance our own team’s future service developments.
(4) Normal biomechanics of the lumbar spine: a
quantitative fluoroscopy and electromyography
study
Alister du Rose
Institute for Musculoskeletal Research and Clinical
Implementation
Research trips to Ghent University (Belgium) and Michigan
State University (USA). Purpose of the trips
• To discuss my PhD work with the leading experts in my
field of study.
• To be exposed to the current thinking in terms of lumbar
biomechanics, and to see the cutting edge equipment that
is being used in research.
The travel fellowship consisted of two trips. The first was to the
Department of Rehabilitation Sciences and Physiotherapy
at the University of Ghent (6th–8th May 2015). The second
75
was to the Michigan State University Center for Orthopedic
Research (15th-19th June 2015). My host(s) in Ghent was
Professor Lieven Danneels and in Michigan were Professors
Jacek Cholewicki and Peter Reeves.
The itinerary for both trips began with a presentation of my
PhD work to the hosts and their research groups (including
PhD students, post docs, engineers, hospital staff and other
professors). This was followed by a question and answer
session, with adequate time for critique and feedback from
the audience. At both institutions the hosts had allocated
the whole of the day to engage in further discussion of
my work, which was conducted until late afternoon (to the
point of exhaustion for everybody). The key points raised
from these discussions are outlined below.
The additional days at each institution were divided
between further discussion and tours of each’s facilities. In
Ghent I was shown the institutions specialist equipment for
lightweight accelerometry, videography, muscle function
testing and 3-D kinematic analysis. In Michigan I visited the
Michigan State Osteopathic Department and was privileged
to visit their wet lab and to see in cadavers the muscles under
investigation in my study. This was followed by laboratory
tours, where I was afforded the opportunity to test for myself
some of the equipment on site.
The two trips were both invaluable to me at such a crucial
stage of my PhD, and have both contributed hugely to
my write-up process. The Ghent trip primarily provided
critique of my methodology and raised my awareness to
some potential methodological limitations that may be
discussed at my PhD viva. The Michigan trip on the other
hand focussed on the broad context of the whole study,
and how to take things forward in terms of future research.
I was also exposed to the current thinking in terms of spinal
biomechanics research, and feel I have made some great
new contacts for future research collaborations.
Of course it was not all work, and the hosts at each institution
generously took me for an evening meal on several
occasions. The highlights for me had to be the view from the
restaurant in Ghent and the cowboy steak I demolished in
Michigan.
In summary, the trip was a huge success both in terms of my
PhD preparation, but also in terms of my development as a
researcher in the field of low back pain and biomechanics.
I wish to thank the SBPR whole heartedly for this fantastic
opportunity.
(5)
Investigating variation in lumbar spine
curvature in asymptomatic individuals with modic
changes and lumbar disc degeneration
Dr Anastasia Pavlova
University of Aberdeen (Arthritis and
Musculoskeletal Medicine, School of Medicine,
Medical Sciences and Nutrition)
Background: Low back pain (LBP) is one of the symptoms
of degenerative lumbar disc disease (DLDD), in addition
to lumbar disc degeneration (LDD) and vertebral end
plate changes (Modic changes). However, many people
with DLDD do not experience back pain and the reason
for this is unknown. A difficulty in predicting who will
suffer from LBP lies in the inability of current imaging to
discriminate between people that experience back pain
(symptomatic) and those that do not (asymptomatic). We
BRITSPINE 2016
Thursday, 7th April
have previously demonstrated a large variation in lumbar
curvatures in healthy individuals using a specialised
method of characterising spinal shape called statistical
shape modelling. The importance of spinal curvature to
the spine’s load-bearing ability was also highlighted. It has
been suggested that there is a mechanical aspect to DLDD
however an association between spinal curvature and
DLDD has not been explored but might provide a way of
discriminating symptomatic and asymptomatic individuals.
Travel Fellowship: I was very fortunate to receive a Travel
Fellowship from the Society for Back Pain Research, funded
by the United Kingdom Spine Societies Board (UKSSB) which
allowed me to address this question. I had the fantastic
opportunity of working with musculoskeletal experts at
Imperial College London by developing a collaboration with
Janet Deane (Arthritis Research UK Allied Health Doctoral
Fellow and Physiotherapist) and Professor Alison McGregor
to explore the role of spine shape in DLDD. I aimed to
combine our expertise in shape modelling with that of
Professor McGregor and Janet Deane in DLDD.
Methods: Janet Deane’s research has created a unique
cohort of asymptomatic (and soon also symptomatic)
individuals with and without LDD and modic changes (MC),
allowing us to develop a pilot project to compare spine
shape between 13 asymptomatic adults aged 45-70 with
and without degenerative changes on magnetic resonance
images (MRI). During my time there I created a statistical
shape model, which I used to characterise spine shape from
the 12th thoracic vertebra down to the first sacral vertebral
bone on each scan. Statistical shape modelling allowed me
to describe the entire spine shape with a small set of scores
(mode scores) that showed how the shape varied from the
average in that sample, and therefore, to easily compare
individuals.
Results and Conclusions: Asymptomatic individuals with
MC in the spine had a more pronounced (lordotic) lumbar
curvature compared to those without (larger Mode 1 score,
P=0.02), who had relatively smaller curvatures. Interestingly,
a recent MRI study in symptomatic patients showed them
to have a flatter spine curve. Although we have yet to use
this technique in symptomatic patients, these early results
suggest that an individual’s spine shape may help us to
discriminate between people who get back pain with MC
and LDD and those that don’t.
This travel fellowship was instrumental in creating this
exciting new collaboration early in my career and I am
extremely grateful. I would also like to thank Alison, Janet
and their colleagues for their hospitality, support and
enthusiasm. I look forward to working together in the future.
(6)Visit to Insight Centre for Data Analytics:
Collaboration towards the development of
wearable technologies for classification and
personalised therapies for back pain
Dr Liba Sheeran
School of Healthcare Sciences, Cardiff University
In November 2015 Liba Sheeran visited the Insight Centre
for Data Analytics at University College Dublin, Ireland,
funded by the the Society of Back Pain Research (SBPR)
Travelling Fellowship that she has been awarded earlier this
year. Insight is funded by the Irish Government and external
research funds including European FP7 to produce world
leading inter-disciplinary high impact research in big data
BRITSPINE 2016
mining and analytics in different environments including
the health sector. Liba was invited by the Insight Director
Professor Brian Caulfield to further develop a wearable
sensor technology device for classifying back pain and
delivering personalised exercise feedback. The visit was
extremely useful producing several outputs: 1) Data towards
a joint publication from 3D spinal kinematics database
identifying the accuracy of different objective classifiers to
subgroup back pain 2) Talk to the Insight’s sensing research
group where Liba presented on wearable technologies for
classifying back pain. This generated interesting discussions
on a design and functionality of an app for the purpose of
classification informed by a clinical judgment 3) Established
firm collaborations for an EPSRC grant currently being
developed by the ARUK BBC co-applicants with Insight’s
data analysts and their industrial partners (Shimmer sensors
and Kinesis).
(7)The science of spinal pain: the way forward for
improved management for people with back pain
Dr Valerie Sparkes
Cardiff University
As a result of the Travel Fellowship awarded by the Society
of Back Pain Research I visited the research laboratories
of Professor Paul Hodges, Director, NHMRC Centre for
Clinical Research Excellence in Spine, Pain, Injury and
Health, University of Queensland, Australia and Professor
Christopher Little, Raymond Purves Bone and Joint Research
laboratories, Kolling Institute of Medical Research, Royal
North Shore Hospital, Sydney, Australia.
At the University of Queensland we visited the laboratories
of Professor Hodges and discussed current research projects.
Of particular interest was a longitudinal study on kinematic
changes and biological markers in patients with a new onset
of pain. To an academic audience of staff and researchers
my colleague, Dr Liba Sheeran presented her work on spinal
research and I presented the work of the Arthritis Research
UK Biomechanics and Bioengineering Centre, Cardiff
University. I explored the concept of using a multifactorial
approach to investigating the causes and management
of osteoarthritis and demonstrated that the Centre had a
membership of over fifty staff and students covering aspects
of bio-chemistry, engineering, biomechanics, rehabilitation
and includes clinical colleagues including orthopaedic
surgeons, rheumatologists and physiotherapists working
across a spectrum of projects. I presented a synopsis of the
work of the Centre with a focus on the rehabilitation aspects
76
Thursday, 7th April
of subjects with osteoarthritis. We explored collaborations
and planned a visit by Professor Hodges to our laboratories
at Cardiff University as part of his visit to the UK in 2015
In Sydney I visited the laboratories of Professor Christopher
Little with whom Professor Hodges has recently worked.
Following a tour of the ‘state of the art’ laboratories we
discussed issues surrounding the lack of a good model of
spinal pain and the complexities of the issues of researching
spinal pain. We discussed the difficulties of distinguishing
the source of spinal pain and the potential role of minor
disc disruption on the stability of the joint and subsequent
symptoms and change in loading. I was also fortunate to
meet Dr Manuela Ferreira, Senior Research Fellow at the
Institute of Bone and Joint Research, and we discussed the
ethical challenges of spinal research. I presented our spinal
research work to a mixed audience of Physiotherapists,
Rheumatologists and Scientists. The presentation was on
the classification of back pain with respect to motor control
impairments and the development of targeted treatments
and I also presented a future project using biological agents
for people with Sciatica.
Outcome of the visit
Professor Hodges came to Cardiff University (July 2015) and
discussed our work and made a presentation of his work and
Dr Liba Sheeran has since gained a Fellowship to spend 8
weeks in Professor Hodges laboratories in May 2016.
16.10-16.40
ADDRESS
How Specialist Associations Support Spinal
Surgeons
Colin Howie/Richard Nelson
Past Presidents of the British Orthopaedic Association and
Society of British Neurological Surgeons, Colin Howie and
Richard Nelson, will discuss the role of the BOA and SBNS
in supporting the professional activities of spinal surgeons
in an environment of complex and continually changing
clinical, regulatory and financial pressures.
A specialised news source
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Issue 32
July 2014
Ibrahim Gündoğdu:
Spinal cord injury
Lori Karol:
Profile
Page 6
Nanna Rolving
Behavioural therapy
Page 12
Page 14
Preoperative opioid use associated with
worse patient-reported outcomes
In two separate reviews, published respectively in The Journal of Bone
and Joint Surgery and in the Journal of Spinal Disorders and Techniques,
investigators at the Vanderbilt University Medical Center have shown that
increased preoperative opioid use is a significant predictor of worse patientreported outcomes and increased hospital stay. However, they did not find
a link between increased preoperative opioid use and an increased rate of
complications.
Index (NDI), and EQ-5D—at
three and 12 months postoperatively. However, multivariate
analysis showed that increased
preoperative opioid use was a
significant predictor of worse
SF-12 PCS, SF-12 MCS, ODI,
NDI, and EQ-5D scores. Lee et
al write that every 10mg increase
in morphine equivalent amount
taken preoperatively in a 24-hour
period predicts a 0.3 decrease in
SF-12 PCS and SF-MCS scores,
a 0.6 increase and 0.5 increase in
the ODI and NDI scores, and a
0.1 decrease in EQ-5D scores at
three and 12 months.
In the study in the Journal of
Spinal Disorders and Techniques, Sheyan Armaghani and
others (including Dennis Lee)
also reviewed data from the
patient population examined in
the first study (Armaghani et al
were all authors in that study).
However, the aim of their study
was to assess whether increasing
amounts of preoperative opioid
use were associated with 30-day
and 90-day complications as well
as increased hospital stay. They
explain that the link between
these outcomes and preoperative opioid use have not been
previously directly evaluated
D
ennis Lee (Department
of Orthopaedics &
Rehabilitation, Vanderbilt University Medical Center,
Nashville, USA) and others
write in The Journal of Bone
and Joint Surgery that although
previous studies have shown
that preoperative opioid use has
a negative impact on spinal surgery outcomes, these studies are
limited and “do not account for
differences in opioid consumption among patients”. They add
that there is also a lack of data
for the effect of preoperative
opioid use on patient-reported
outcomes. The aim of their study
was therefore to: “Investigate
whether the amount of preoperative opioid use predicted worse
postoperative patient-reported
outcomes at three and 12 months
following spinal surgery.”
Lee et al reviewed data for 583
patients who underwent lumbar,
thoracolumbar, or cervical spine
surgery at the Vanderbuilt Medical Center between October 2010
and June 2012. In this patient
population, the mean age was
57±13.2, 54% were female, and
lumbar fusion was the most common surgery performed (35% of
patients). The median preoperative daily morphine equivalent
amount was 8.75mg (interquartile range 0–36.5mg), with 56%
of patients reporting some degree
of preoperative opioid use.
All patients, regardless of preoperative opioid use, had significant improvements in the study’s
outcome measures—MannWhitney U tests, SF-12 physical
component summary (PCS), and
mental component summary
(MCS), Oswestry Disability
Index (ODI), Neck Disability
Tantalum porous implant is a good
alternative to plate and autograft in ACDF
Ana Torres (Hospital Universitario Santa Lucia, Cartagena, Spain)
reported at the European Federation of National Associations
of Orthopaedics and Traumatology congress (EFORT; 4–6 June,
London, UK) that a tantalum porous implant (TM-S, Zimmer Spine)
is a good alternative to autograft and plate in anterior cervical
discectomy and fusion (ACDF) because it is associated with cost
savings of €1,473 per patient per year.
T
orres commented that avoiding
the “inconveniences” of autograft
harvesting for fusion procedures
had “considerable advantages”, which
included reducing surgical time. However, she added that long-term follow-up
data for alternatives to autograft were
limited. “It is necessary to examine the
potential increased costs associated with
porous tantalum implants compared with
traditional treatment,” She noted.
In the study, 61 patients with singlelevel cervical disc disease with radiculopathy were randomised to receive ACDF
with the tantalum porous implant or to
receive ACDF with autograft and plate
(control group). Clinical status was evaluated using the pain Visual Analogue Scale
(VAS), the Neck Disability Index (NDI),
and the Zung Depression Scale. The
investigators also evaluated the patients’
subjective satisfaction, the complication
rate, and the cost-effectiveness of the
procedures.
The tantalum group were associated
with significant reductions in mean duration of surgery, mean estimated blood
loss, and hospital stay compared with the
control group. At five years, both groups
(compared with their baseline levels) had
significant improvements in NDI scores,
VAS scores, SF-36 physical component
scores, and SF-36 mental component
scores with no significant differences in
these outcome measures between groups.
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potential increased costs associated with
limited. “It is necessary to examine the
data for alternatives to autograft were
ever, she added that long-term follow-up
included reducing surgical time. Howhad “considerable advantages”, which
harvesting for fusion procedures
the “inconveniences” of autograft
orres commented that avoiding
ated using the pain Visual Analogue Scale
(control group). Clinical status was evalureceive ACDF with autograft and plate
with the tantalum porous implant or to
athy were randomised to receive ACDF
level cervical disc disease with radiculopIn the study, 61 patients with singletraditional treatment,” She noted.
porous tantalum implants compared with
savings of €1,473 per patient per year.
discectomy and fusion (ACDF) because it is associated with cost
is a good alternative to autograft and plate in anterior cervical
London, UK) that a tantalum porous implant (TM-S, Zimmer Spine)
of Orthopaedics and Traumatology congress (EFORT; 4–6 June,
reported at the European Federation of National Associations
Ana Torres (Hospital Universitario Santa Lucia, Cartagena, Spain)
these outcome measures between groups.
scores with no significant differences in
scores, and SF-36 mental component
VAS scores, SF-36 physical component
significant improvements in NDI scores,
(compared with their baseline levels) had
control group. At five years, both groups
loss, and hospital stay compared with the
tion of surgery, mean estimated blood
with significant reductions in mean duraThe tantalum group were associated
procedures.
rate, and the cost-effectiveness of the
subjective satisfaction, the complication
investigators also evaluated the patients’
and the Zung Depression Scale. The
(VAS), the Neck Disability Index (NDI),
alternative to plate and autograft in ACDF
Tantalum porous implant is a good
thoracolumbar, or cervical spine
patients who underwent lumbar,
Lee et al reviewed data for 583
following spinal surgery.”
outcomes at three and 12 months
postoperative patient-reported
tive opioid use predicted worse
whether the amount of preoperawas therefore to: “Investigate
outcomes. The aim of their study
opioid use on patient-reported
for the effect of preoperative
that there is also a lack of data
tion among patients”. They add
differences in opioid consumplimited and “do not account for
gery outcomes, these studies are
a negative impact on spinal surthat preoperative opioid use has
previous studies have shown
and Joint Surgery that although
write in The Journal of Bone
Nashville, USA) and others
bilt University Medical Center,
Rehabilitation, Vanderof Orthopaedics &
ennis Lee (Department
tile range 0–36.5mg), with 56%
amount was 8.75mg (interquartive daily morphine equivalent
patients). The median preoperamon surgery performed (35% of
lumbar fusion was the most com57±13.2, 54% were female, and
population, the mean age was
and June 2012. In this patient
cal Center between October 2010
surgery at the Vanderbuilt Medi-
Index (ODI), Neck Disability
(MCS), Oswestry Disability
mental component summary
component summary (PCS), and
Whitney U tests, SF-12 physical
outcome measures—Manncant improvements in the study’s
operative opioid use, had signifiAll patients, regardless of preof preoperative opioid use.
of patients reporting some degree
complications.
a link between increased preoperative opioid use and an increased rate of
reported outcomes and increased hospital stay. However, they did not find
increased preoperative opioid use is a significant predictor of worse patientinvestigators at the Vanderbilt University Medical Center have shown that
and Joint Surgery and in the Journal of Spinal Disorders and Techniques,
In two separate reviews, published respectively in The Journal of Bone
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and e-newsletter subscription** visit
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spine interbody fusion.”
implant is a good alternative for cervical
autograft and plate. The tantalum porous
less costly and more effective than using
stand-alone device in ACDF procedures is
using a porous tantalum implant as a
Torres said: “These data show that
savings of €1,473 per patient per year.
tantalum implant was associated with cost
year gained per patient between groups, the
difference in mean quality adjusted life
more, while there was not a significant
vs. €5,026, respectively; p<0.01). Furthergroup than for the tantalum group (€7,287
was significantly higher for the control
The mean cost of the index procedure
(p<0.05).
tantalum group: 12 vs. 3, respectively
in the control group compared with the
index procedure was significantly higher
reported from two to five years after the
However, the number of complications,
previously directly evaluated
tive opioid use have not been
these outcomes and preoperaexplain that the link between
as increased hospital stay. They
and 90-day complications as well
use were associated with 30-day
amounts of preoperative opioid
was to assess whether increasing
However, the aim of their study
were all authors in that study).
the first study (Armaghani et al
patient population examined in
also reviewed data from the
others (including Dennis Lee)
niques, Sheyan Armaghani and
Spinal Disorders and TechIn the study in the Journal of
three and 12 months.
0.1 decrease in EQ-5D scores at
the ODI and NDI scores, and a
a 0.6 increase and 0.5 increase in
SF-12 PCS and SF-MCS scores,
period predicts a 0.3 decrease in
taken preoperatively in a 24-hour
in morphine equivalent amount
al write that every 10mg increase
NDI, and EQ-5D scores. Lee et
SF-12 PCS, SF-12 MCS, ODI,
significant predictor of worse
preoperative opioid use was a
analysis showed that increased
tively. However, multivariate
three and 12 months postoperaIndex (NDI), and EQ-5D—at
D
Available on three different
platforms: print, web and
mobile application
However, the number of complications,
reported from two to five years after the
index procedure was significantly higher
in the control group compared with the
tantalum group: 12 vs. 3, respectively
(p<0.05).
The mean cost of the index procedure
was significantly higher for the control
group than for the tantalum group (€7,287
vs. €5,026, respectively; p<0.01). Furthermore, while there was not a significant
difference in mean quality adjusted life
year gained per patient between groups, the
tantalum implant was associated with cost
savings of €1,473 per patient per year.
Torres said: “These data show that
using a porous tantalum implant as a
stand-alone device in ACDF procedures is
less costly and more effective than using
autograft and plate. The tantalum porous
implant is a good alternative for cervical
spine interbody fusion.”
Spinalnewsinternational.com
T
Editorially independent
in patients undergoing spinal
surgery.
They found that preoperative
opioid use, in a multivariate
analysis, was not significant
predictor for an increased rate
of complications at 30 days or
for an increased rate of complications at 90 days. However,
they did find that its use was a
significant predictor (p=0.006) of
length of stay in hospital. “Based
on the β coefficient of preoperative narcotic use in our linear
regression analysis of length of
stay, we calculated that for every
100 morphine equivalents a
patient is taking preoperatively,
their stay is extended 1.1 days,”
Armaghani et al write.
Lee told Spinal News International: “Our work highlights the
importance of careful preoperative counselling with patients
on high doses of preoperative
opioids, pointing out the potential impact on long-term outcome
and working toward opioid
reduction prior to undergoing surgery. Consideration of
preoperative multimodal pain
agents in conjunction with appropriate referral to psychiatric and
addiction specialists may help in
achieving this goal.”
achieving this goal.”
addiction specialists may help in
priate referral to psychiatric and
agents in conjunction with appropreoperative multimodal pain
ing surgery. Consideration of
reduction prior to undergoand working toward opioid
tial impact on long-term outcome
opioids, pointing out the potenon high doses of preoperative
tive counselling with patients
importance of careful preoperational: “Our work highlights the
Lee told Spinal News InternaArmaghani et al write.
their stay is extended 1.1 days,”
patient is taking preoperatively,
100 morphine equivalents a
stay, we calculated that for every
regression analysis of length of
tive narcotic use in our linear
on the β coefficient of preoperalength of stay in hospital. “Based
significant predictor (p=0.006) of
they did find that its use was a
cations at 90 days. However,
for an increased rate of compliof complications at 30 days or
predictor for an increased rate
analysis, was not significant
opioid use, in a multivariate
They found that preoperative
surgery.
in patients undergoing spinal
*Available for US and EU readers only
**Available worldwide
worse patient-reported outcomes
Preoperative opioid use associated with
Page 6
Page 12
Spinal cord injury
Profile
Available
now
Ibrahim
Gündoğdu:for iPad and iPhone
Lori Karol:
Issue 32
77
Page 14
Behavioural therapy
Nanna Rolving
July 2014
facebook.com/
spinalnews
@SN_publishing
BRITSPINE 2016
Thursday, 7th April
Podium Presentations
Best of Show
(32) 15.10-15.20
(31) 15.00-15.10
Main Author: Kyle McDonald
Co Authors: Hean Wu Kang, Niall Eames, Richard Napier
Affiliation: Fractures Department, Royal Victoria Hospital,
274 Grosvenor Road, Belfast BT12 6BA
Conflicts of Interest: No conflicts of interest.
Funding Sources: No funding obtained.
Background Context: Waiting times for patients
undergoing elective spinal surgery at Royal Victoria Hospital
(RVH) are increasing due to increasing trauma commitments
in the unit. Prior to surgery, consultants require ‘up-to-date’
MRI scans performed within 12 months from date of surgery.
Purpose: To evaluate necessity of aforementioned scans,
and potential cost implications
Study Design/Setting: Retrospective analyses of 50
consecutive patients who underwent elective anterior
cervical discectomy and fusion (ACDF) over the previous 12
months
Patient Sample: 50 patients included in analysis
Outcome Measures: Not applicable
Methods: Comparison between MRI scans were made,
looking at whether repeat scans identified any radiological
changes, and if so, was the original surgical procedure
altered as a result.
Results: Average time between first and final MRI scans was
22.7 months. 43 patients had two MRI scans, 6 had three MRI
scans, and 1 patient had four scans. Only 3 out of 50 patients
had changes from their first MRI scan. However, none of
these changes altered the surgical intervention.
Conclusions: Repeating MRI scans has both monetary and
time costs to the service, each scan costing approximately
£500 and taking up a 30 minute MRI slot. Given the above
results we propose extending the period between repeat
scans to 24 months, thus producing a saving amongst these
patients of £24,000 and future savings of approximately
£75,000 per year.
Interspinous process fixation versus pedicle screw
fixation in circumferential arthrodesis: 1-year
outcomes from a prospective randomized multicenter trial
Main Author: Ryan Denhaese
Co Authors: Kee Kim; Clint Hill; Brandon Strenge; Alex de
Moura, Peter Passias, Andy Kranenburg, Michael Dennis,
Andy Cappuccino, Ty Thaiyananthan, Paul Arnold, Brieta
Bejin, Camille Moore, Sarah Martineck, Chris Ferry, Kim
Martin
Affiliation: AXIS Neurosurgery and Spine, 19 Limestone
Drive, Suite 11, Williamsville, NY 14221, USA
Conflicts of Interest: Consultants (Fees) of Zimmer Biomet
Spine: R Denhaese; K Kim; B Strenge; C Hill; C Moore; S
Martineck
Employees (Salary) of Zimmer Biomet Spine: B Bejin; C Ferry;
K Martin
Funding Sources: Study funded by Zimmer Biomet Spine
(ClinicalTrials.gov ID: NCT01549366)
Background Context: Interspinous process fixation (ISPF)
has gained favor as a minimally disruptive alternative to
pedicle screw fixation (PSF) when supporting circumferential
arthrodesis. However, it is still unclear whether the
biomechanical rigidity of ISPF is sufficient enough to achieve
and maintain clinically advantageous outcomes similar to
that of PSF.
Purpose: Prospectively compare the outcomes of subjects
receiving lumbar interbody fusion (IBF) supplemented with
either ISPF or PSF.
Study Design/Setting: This was a prospective randomized
controlled multi-center (11 investigators).
Patient Sample: 103 subjects receiving single-level
interbody fusion with supplemental ISPF (n=66) or PSF
(n=37) for the treatment of degenerative disc disease +/spondylolisthesis. The randomization ratio was 2:1, ISPF to
PSF subjects. The PSF approach (MIS or open; unilateral or
bilateral) and interbody access approach (lateral or anterior)
were per investigator institutional standard-of-care.
Outcome Measures: Perioperative outcomes, patient
reported outcomes, and radiographic/CT fusion assessment
outcomes were collected through 12months.
Methods: Comparative analysis was performed using a
linear mixed model (p<0.05).
Results: No statistically significant differences were
observed between cohorts with respect to change in
patient reported outcome scores (ODI, SF-36, ZCQ, and NRS/
VAS) from baseline to 1.5, 3, 6, or 12months. ISPF subjects
did demonstrate a greater mean decrease in ODI across all
time points. Radiographic/CT assessment of subsidence and
fusion scores demonstrated comparable outcomes between
cohorts. 92% of ISPF subjects exhibited bone formation
bridging the spinous processes.
Conclusions: ISPF subjects demonstrated clinically
advantageous trends across all follow-up metrics; achieving
outcomes comparable/favorable to that of PSF.
BRITSPINE 2016
How “up to date” should pre-operative scans be?
(33) 15.20-15.30
Therapeutic efficacy of particulate vs nonparticulate steroids for cervical and lumbar
radiculopathy
Main Author: Nanjundappa S Harshavardhana1
Co Authors: Harshad V Dabke2
Affiliation: 1TRoyal National Orthopaedic Hospital NHS
Trust, Stanmore and 2Salisbury District Hospital, Wiltshire
Conflicts of Interest: None
Funding Sources: No funding
Background Context: Selective nerve root blocks (SNRB)
by transforaminal epidural steroid infiltration (TFESI) is
used in non-operative management of cervical and lumbar
radiculopathy(C&LR). Particulate steroids (PS) are perceived
to be more effective providing long-lasting pain relief in
comparison to non-particulate steroids (NPS).
Purpose: To determine if TFESI with use of NPS were
therapeutically inferior to PS for C&LR and to report the risk
78
Thursday, 7th April
ratio(RR) with 95% confidence intervals(CI) of pain relief
following TFESI with NPS and PS.
Study Design/Setting: Systematic review with metaanalysis.
Patient Sample: All published LoE I-III clinical studies
involving adults with C&LR treated with SNRB by TFESI.
Outcome Measures: Pain relief on VAS and NDI/ODI.
Methods: A comprehensive search was undertaken in
MEDLINE, EMBASE and Cochrane database for published
full-text articles on TFESI for C&LR. We extracted the data
collecting patient demographics and clinical outcomes
using a standardized form and adhered to the PRISMA
guidelines. Comprehensive meta-analysis software version
three (CMA-v3) was used to undertake meta-analysis.
Results: Six studies with pooled data of 874patients
(452PS/422NPS and 399/475) were included in the
systematic review. The mean age at the time of TFESI was
52.5years and follow-up was 4–180days (mean 58days).
There was no difference in therapeutic efficacy between
NPS vs. PS. The RR for pain relief in patients who received
PS though better was not statistically significant on random
effects model (RR=1.23; 95%CI=0.90–1.57 and p=0.22). The
break-down of patient demographics for all six studies with
forest plots are attached below.
Conclusions: NPS were NOT found to be inferior to PS and
we recommend routine use of NPS when performing a SNRB
with TFESI.
Conflicts of Interest: None
Funding Sources: National Institute for Health Research
Background Context: The standard approach of monitoring
scoliosis involves using the Cobb angle from postero-anterior
(PA) radiograph. This approach has two key limitations: 1) It
involves exposing the patients to ionising radiation during a
period of heightened radiosensitivity. 2) The 2D x-ray image
is a projection image of a 3D deformity and the Cobb angle
represents only lateral rotation. 3D ultrasound (3DUS) could
overcome both these limitations.
Purpose: To demonstrate the ability of 3DUS for monitoring
scoliosis.
Study Design/Setting: Cross sectional observational
analytic/Tertiary referral centre
Patient Sample: Seven female patients with adolescent
idiopathic scoliosis (AIS) with a mean age (+ SD) of 13.3 years
+ 1.9 years
Outcome Measures: Level of agreement between CT and
3DUS (axial rotation angle) and 3DUS and x-ray (Cobb
angles)
Methods: We developed a 3DUS system by combining
motion capture technology, a conventional 2D ultrasound
scanner and bespoke software. An in vitro experiment and
a pilot clinical study were carried out to demonstrate the
system’s ability to identify vertebral landmarks and quantify
the Cobb and axial rotation angles. For the in vitro validation,
a spine phantom with simulated axial rotation was scanned
CT and 3DUS. The AIS patients were scanned with x-rays and
3DUS and the Cobb angles compared.
Results: The spinous and transverse processes were easily
identifiable in 3DUS. The mean difference in the axial rotation
measurements was 0.56⁰ + 0.47⁰. The mean difference in the
Cobb angle measurements was 5.1⁰ + 2.5⁰.
Conclusions: The results of this pilot study demonstrate
3DUS as a promising tool for quantifying spine curvature in
three dimensions.
Figure 1: 3DUS of the spine. The spinous processes (SP) and
laminae are highlighted on the transverse image on the left.
3D automated rendering of the spine from the ultrasound
data is shown on the right.
(35) 15.40-15.50
(34) 15.30-15.40
The development and validation of a 3D ultrasound
system for monitoring curve progression of patients
with scoliosis
Main Author: Eskinder Solomon
Co Authors: Adam P Shortland, Adnan K Meyer, Jonathan
D Lucas
Affiliation: Guy’s and St Thomas NHS Foundation Trust
79
Do surgeons need to rescrub during operations that
last longer than three hours?
Main Author: Pooria Hosseini:
Co Authors: Gregory M Mundis Jr, Robert Eastlack, Jeff
Pawelek, Stacie Nguyen, Behrooz A Akbarnia
Affiliation: San Diego Spine Foundation, 6190 cornerstone
Ct, Ste 212, San Diego, California 92121, USA
Conflicts of Interest: Behrooz A. Akbarnia - Nuvasive, K2M,
DePuy Synthes (a), Ellipse, Nuvasive, K2M (d), Nuvasive,
Ellipse(f ), ISSGF, Nuvasive, K2M (g), GSF, SDSF, SRS, SOLAS (h);
Gregory Mundis - Nuvasive (a,d,g), K2M (a,d), Medicrea (d),
BRITSPINE 2016
Thursday, 7th April
Misonix (d), ISSGF (g), SOLAS, SRS, SDSF (h); Robert Eastlack
- Globus Medical (a), Aesculap/B.Braun (b,d); DePuy (b),
Johnson & Johnson Company (b); Eli Lilly (b); Nuvasive (b,d);
Synthes (b), DiFusion (d,f); Invuity (d,f); K2M (d); Alphatec
Spine Nuvasive (f); Globus Nuvasive Pioneer Alphatec Baxano
Lanx (g), Scoliosis Research Society; Society of Lateral Access
Surgery (h), Pioneer Nuvasive (i)
For the remaining authors none were declared.
(a) Royalties (b) Speakers bureau/paid presentations (c) Paid
employee (d) Paid consultant (e) Unpaid consultant (f) Stock
or stock options (g) Research support from a company or
supplier as a PI (h) Board member/committee appointments
for a society (i) Other financial or material support
Funding Sources: San Diego Spine Foundation funded this
study
Background Context: Despite advances in infection control,
surgical site infection remains a substantial cause of morbidity
especially in long operations (>3 hours). There is evidence
that the efficacy of the scrubbing material fades away after
three hours. Hence, it can be postulated that the surgeon’s
hands may become a progressive source of contamination
during surgery.
Purpose: We aimed to determine the level of hand
contamination after operations lasting more than 3 hours.
Study Design/Setting: Level II prospective study
Patient Sample: Three spine surgeons meeting the inclusion
criteria.
Outcome Measures: Level of hand contamination, type of
contamination
Methods: Three spine surgeons used the same scrubbing
technique and material enrolled. Exclusion criteria: procedures
less than three hours, and operations with perforated gloves.
Twenty consecutive spine surgeries were included. Hands
were swabbed with 5 ml sterile 75 mM Phosphate Buffered
Saline with 0.1% Triton-X at prior to hand scrubbing (prescrub), immediately following hand scrubbing (post-scrub)
and immediately following surgery (post-operative).
Results: All samples had zero colony count at post-scrub.
None of the cases lasting 3-4 hours had colony growth postoperatively. Surgeries that were at least five hours had the
post-operative colony count reach the same level or higher
than the pre-scrub. The longer the operation, the higher
the level of contamination post-operatively with a linear
regression coefficient of 0.89 and p=0.005. Fig 1.
Conclusions: Our results demonstrate that after four hours,
a surgeon’s hands become recolonized, despite preoperative
scrubbing. In some cases, there was higher colony forming
unit / ml after the procedure than before any scrubbing had
occurred. Based on these findings, consideration should be
given to rescrubbing during the course of surgical procedures
extending beyond four hours.
Fig
(36) 15.50-16.00
Social drift - a comparative analysis of balloon
kyphoplasty for osteoporotic vertebral compression
fractures and surgery for fractured neck of femur
Main Author: Edmund Charles
Co Authors: Shashi Kumar Nanjayan, Konstantinos Mitsiou,
Girish Swamy, Rajendra Bommireddy, Zdenek Klezl
Affiliation: Royal Derby Hospital, Derbyshire NHSFT,
Uttoxeter Road, Derby DE22 3NE
Conflicts of Interest: None
Funding Sources: None
Background Context: Fracture neck of femur (NOF) and
Osteoporotic Vertebral Compression Fracture (OVCF) have
a significant effect on patients’ social function. Downward
drift in social functional status has been described (Social
Drift). Surgical priority for fracture NOF is well established.
Purpose: We analysed the incidence of social drift and
mortality following balloon kyphoplasty for OVCF and
surgery for fracture NOF in patients who lived in their own
home.
Study Design/Setting: Prospective cohort study from
2007-2012.
Patient Sample: NOF group had 1966 patients (1414 female,
mean 79 years) and OVCF group had 230 patients (152
female mean 72 years). Sample size was fair representation
of each group considering the incidence of injury.
Outcome Measures: Social function status was documented
pre-injury and at discharge after treatment/rehabilitation in
both groups. ‘Social Drift’ was documented and categorised
as ‘own home’, ‘residential home’, ‘nursing home’ or ‘death’.
Methods: We analysed age, sex and type of operation
received for NOF group and age, sex and number of levels of
kyphoplasty for OVCF group. (univariate ANOVA)
Results: NOF group showed 12.3% downward social drift
and 33.4% mortality. OVCF group showed 8.3% downward
social drift and 27.4% mortality. Age, sex and type of
operation were all significant predictors of NOF ‘downward
drift’ (p<0.01). Age was a significant predictor for OVCF
(p=0.007) but sex and number of levels of kyphoplasty were
not.
Conclusions: Interestingly, following surgical treatment,
downward social drift and mortality after OVCF and
fracture NOF were similar. We ask should OVCF deserve a
similar treatment priority as fractured NOF? Further larger
comparative studies including conservatively managed
groups are recommended.
(37) 16.00-16.10
Are we ready for transfusing intraoperative
salvaged blood in metastatic spine tumour surgery
Main Author: Naresh Kumar1
Co Authors: Aye Sandar Zaw1, Qasim Ahmed2, Victor Lee2,
Hee-Kit Wong1, Aravind Kumar3
Affiliation: 1.Department of Orthopaedic Surgery, National
University Health System, Singapore, 2.Department
of Pathology, National University Hospital, Singapore,
3.Department of Orthopaedic Surgery, Khoo Teck Puat
Hospital, Singapore
BRITSPINE 2016
80
Thursday, 7th April
Conflicts of Interest: None
Funding Sources: None
Background Context: Metastatic spine tumour surgery
(MSTS) often requires blood transfusion. Intraoperative
salvaged blood is a good option but it has been avoided
in tumour surgery because of the concern of reinfusing
tumour cells.
Purpose: To evaluate the feasibility of using intraoperative
cell salvage (IOCS) in combination with leucocyte depletion
filter (LDF) in eliminating tumour cells from blood salvaged
during MSTS
Study Design/Setting: Prospective observational
Patient Sample: Fifty consecutive patients with known
primary epithelial tumour, undergoing MSTS, were recruited.
Outcome Measures: Presence/absence of tumour cells
Methods: Blood samples were collected at three different
stages during surgery: A) from operative field prior to IOCS
processing, B) after IOCS processing and C) after IOCS-LDF
processing. Blood samples (15ml each) were taken at each
stage and examined by cell block technique to identify
tumour cells of epithelial origin. The proportion of patients
with tumour cell negative in stage A and C and stage A and B
were compared using two sample proportion tests.
Results: The proportion of patients with negative tumour
cells in stage A was 68%, stage B was 92% and stage C was
100%. There was a significant difference between stage A
and stage C (P<0.01), proving that IOCS-LDF was able to
eliminate all the tumour cells in salvaged blood. A significant
difference was also observed between stage A and stage
B (P<0.01), indicating IOCS alone could be adequate for
removing tumour cells.
Conclusions: The findings support the notion that IOCSLDF eliminates tumour cells from salvaged blood. Use
of salvaged blood could be safe in MSTS and even in
musculoskeletal tumour surgery.
Podium Presentations
British Association of Spine Surgeons (BASS)/
British Scoliosis Society (BSS)
Infection/Tumour
(38) 09.00-09.10
Gentamicin fleece and the incidence of surgical site
infections following spinal deformity surgery for
adolescent idiopathic scoliosis
Main Author: Muhammad Adeel Akhtar
Co Authors: C Honeyman, F Aziz, R Kalyan, W Hekal
Affiliation: The James Cook University Hospital, Marton
Road, Middlesbrough TS4 3BW
Conflicts of Interest: None
Funding Sources: None
Background Context: The incidence of surgical site
infection (SSI) after spinal deformity surgery for adolescent
idiopathic scoliosis ranges from 0.5–6.7%. Local application
of antibiotics to the wound has been shown to reduce rates
of SSI after spinal fusion.
81
Purpose: Our purpose was to study the incidence of SSI
following deformity correction surgery with the use of
Gentamicin fleece in addition to intravenous antibiotics.
Study Design/Setting: A prospective observational study
Patient Sample: 70 patients undergoing spinal deformity
correction surgery
Outcome Measures: Incidence of surgical site infection
Methods: We prospectively studied 70 patients between
December 2010 and August 2015 for the incidence of
surgical site infection. All patients had a standardized
antibiotics regimen pre and post operatively along with
the addition of local antibiotics in the wound in the form of
gentamicin fleece.
Results: The mean age for 58 female and 12 male patients
was 14.8 years (range 9-19). Types of curves were Double
57%, Thoracic 37%, Lumbar 3% and early onset 3%. The
mean time from presentation to surgery was 1 year (range
0-4). The mean length of hospital stay was 6 days (range
4-15). The mean height gain was 4.2 cm (range 1.5-7.6).
There were no reported cases of surgical site infection in our
cohort.
Conclusions: Our incidence of SSI following spine deformity
correction was 0%. We believe that addition of local
antibiotics to a standardized antibiotics regimen can help
to achieve this goal. We are currently measuring gentamicin
levels in the drain fluid to confirm our observations.
(39) 09.10-09.20
Single stage anterior corpectomy and posterior
instrumentation in tuberculous spondylitis with
varying degrees of neurological deficit
Main Author: Ujjwal K Debnath
Co Authors: Jeffrey R McConnell
Affiliation: Ramakrishna Mission Seva Pratisthan, Kolkata
700026, India
Conflicts of Interest: None
Funding Sources: None
Background Context: Surgical treatment is recommended
in tubercular (TB) spondylitis with varying neurological
deficit
Purpose: Analyse the outcome in Potts spine treated with
single stage combined approach
Study Design/Setting: Retrospective case series
Patient Sample: 19 (6M: 13F) patients with spinal TB and
neurological deficits underwent surgery with mean age of
34.8 years (r 2-65years).
Outcome Measures: VAS (Visual Analogue Score), Frankel
grading, Clinical and Radiological healing
Methods: Mean duration of symptoms was 7 months (r
3m -1y). Anti-TB chemotherapy was initiated in all patients.
All had a mean follow-up period 16 months. Levels of
involvement were: 1 upper cervical, 10 thoracic and 8
lumbo sacral. 7 patients were Frankel Grade A/B, 8 Frankel
Grade C (unable to walk even with support) and 4 patients
had Frankel Grade D (walk with support but weak legs) on
admission. The kyphotic angle ranged from 5° to 40° before
operation, with an average of 18° ± 12°. All had single stage
anterior corpectomy, debridement with or without cage
insertion and posterior instrumented fusion.
BRITSPINE 2016
Thursday, 7th April
Results: Mean VAS reduced from 6.8 to 2.7 by 3weeks
postop. 17/19 patients (89.4%) neurological deficit had
excellent or good clinical results (P > 0.05). Mean ESR was
normal (10 ± 5mm/h) within 6 months. The average kyphotic
angle decreased to 7 ° ± 5° postoperatively. Solid fusion was
achieved in all cases without loss of deformity correction.
Conclusions: Combined single stage surgery helps to
correct and maintain the deformity, foci clearance, spinalcord decompression and pain relief in the treatment of
tuberculous spondylitis with neurological deficit.
(40) 09.20-09.30
Should spinal MRI scans be used to determine the
duration of therapy for spinal tuberculosis?
Main Author: Emily McGhee
Co Authors: Kolera Chengappa, Ronan Breen, Heather
Milburn, Jonathan Lucas
Affiliation: Guy’s and St Thomas’ NHS Foundation Trust,
Guy’s Hospital, Great Maze Pond, London SE1 9RT
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: National guidelines for treatment
of spinal TB (sTB) recommend a 6 month quadruple
chemotherapy regimen. Spinal MRI is increasingly used to
monitor disease progression as optimal treatment duration
remains uncertain.
Purpose: To investigate presenting symptoms, treatment
duration and role of MRI in sTB management.
Study Design/Setting: Retrospective study.
Patient Sample: All individuals presenting with sTB to Guy’s
and St Thomas’ Hospital between 2007-2014.
Outcome Measures: Self-report: symptoms during
treatment.
Physiologic: spinal MRI findings.
Methods: Clinical records of 48 individuals with sTB were
examined.
Results: Mean age of onset was 38.6(17-64) years and
symptom duration before diagnosis was 9.8(0.25-40) months.
Most of delay (8.5 months) was due to late referral to the
tertiary centre. Back pain and neurological symptoms were
present in 90% and 50% respectively. Treatment duration
was 10.5(5-18) months; 15% required surgical intervention.
98% of patients had a spinal MRI scan; 2.7(1-7) repeat scans
were performed/person. 35 subjects had an MRI scan after 6
months, 6% received treatment for ≤6months and 94% for
>6months. MRI evidence of osteomyelitis and/or abscess
was present in 94% of subjects treated for >6months; 6%
had no evidence of osteomyelitis/abscess, however marrow
oedema was evident. In individuals treated for >6months,
48% had complete resolution of osteomyelitis/abscess, 9%
had significant improvement but incomplete resolution,
18% are receiving ongoing treatment, 24% had no further
scans. Resolution of osteomyelitis/abscess corresponded to
symptoms (84% and 16% had symptoms at 6 months and at
end of treatment respectively).
Conclusions: Treatment duration was frequently longer
than recommended by guidelines. Osteomyelitis/abscess on
MRI may be a useful criteria for identifying patients requiring
>6months treatment.
BRITSPINE 2016
(41) 09.30-09.40
A cost-utility analysis of surgical intervention in
metastatic spinal cord compression (MSCC)
Main Author: Bilal A S Chaudhry
Co Authors: Naveed Yasin, Saeed Mohammad, Rajat Verma,
Irfan Siddique
Affiliation: Salford Royal Hospital
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Surgery for metastatic spinal cord
compression is aimed at improving quality of life, but the
complexity and often extensive surgery together with the
perioperative care of these patients carries a significant cost.
Purpose: To evaluate and contextualise the cost utility of
surgery for MSCC.
Study Design/Setting: This retrospective study of 112 cases
was conducted within a tertiary spinal centre.
Patient Sample: n = 112
Outcome Measures: (1) Cost per QALY gained, (2) Average
cost of surgical intervention
Methods: We retrospectively analysed 112 cases of surgical
intervention for MSCC. The average cost of surgery was
calculated through patient-level costing data with individual
case adjustment for true implant cost. Subsequently, a costutility analysis was completed using surrogate values for
QALYs gained extracted from previously published literature.
Results: Average cost of surgical intervention = £16,919;
Cost per QALY gained = £29,683
Conclusions: The cost-effectiveness of the surgical
management of MSCC is in accordance with the £30,000
threshold published by NICE. This deems surgical
intervention as cost-effective and allows for comparison
against other interventions of similar or differing modality
and medical value. In addition, this data highlights that any
proposed reductions in the tariff for these procedures to
below £16,000 will cause significant problems for providers.
(42) 09.40-09.50
Outcomes of revision surgery for spinal metastatic
disease
Main Author: Zak Choudhury
Co Authors: Navi Bali, Sam Chan, Simon Hughes, Stuart
Harrisson, Alistair Stirling, Mel Grainger
Affiliation: Royal Orthopaedic Hospital, Birmingham UK
Conflicts of Interest: no conflicts of interest
Funding Sources: no funding obtained
Background Context: Surgery for spinal metastatic disease
has been proven to be effective in maintaining quality of life
but there is little to demonstrate the value of revision surgery
in this cohort of patients with potentially limited prognosis.
Purpose: To identify indications for further surgery and
review patient outcomes including survival along with
complications of surgery
Study Design/Setting: Retrospective review of patients
treated between 1994- 2015 to identify those having revision
surgery for spinal metastatic disease.
82
Friday, 8th April
Patient Sample: Patients undergoing revision surgery for
spinal metastatic disease
Outcome Measures: Survival data, recorded complications
including further recurrence and Frankel grade assessment
Methods: Review of histological database to confirm
diagnosis, cross referenced with theatre logs and case notes.
Results: We identified 733 patients with complete data
who had spinal metastatic tumour surgery at our unit, with
44(18F, 26M) having a total of 50 revisions (6 patients had
three procedures). Our revision surgery rate was 6%.
Indications for revision were loss of fixation (10), local
recurrence (21) and distant recurrence (13). Mean time
between initial and revision surgery was 11.2 months (range
1-54 months).
37 patients died at mean 17.5 months post revision (range
1m-91m), 6 survive at the current time (10- 171 months)
and 1 is lost to follow up. Frankel grade was preserved in all
cases. Complication rate was 13.6%, equivalent to published
data for non-tumour revision decompression surgery.
Conclusions: Our data demonstrate that revision surgery
in spinal metastatic disease is appropriate even for local
recurrent disease in selected patients with acceptable
complication rate.
(43) 09.30-09.40
Outcome and health related quality of life after
surgery for spinal metastases
Main Author: Nasir A Quraishi
Co Authors: G Arealis, D Pasku, B M Boszczyk, K L Edwards
Affiliation: Centre for Spinal Studies and Surgery, Queens
Medical Centre Campus of Nottingham University Hospitals
NHS Trust, West Block, D Floor, Derby Road, Nottingham
NG7 2UH
Conflicts of Interest: Departmental research/fellowship
support Depuy Synthes, Medtronic
Funding Sources: Nil
Background Context: Spinal metastases is a common
condition that may lead to neurological compromise, spinal
instability and incapacitating pain. Surgical treatment has
been shown to improve pain, function and neurological
outcome.
Purpose: Our aim was to analyse the outcome and health
related quality of life in a prospective series of patients
undergoing surgery for spinal metastases at a single tertiary
referral centre.
Study Design/Setting: Prospective cohort study (20092013)
Patient Sample: 199 patients with symptomatic spinal
metastases
Outcome Measures: Pre- and post-operative assessment
of Frankel neurological status, visual analogue score (VAS)
for pain, Euroqol EQ-5D quality of life, Karnofsky physical
functioning score, Oswestry Disability Index (ODI), SF-36,
complication rates and survival were recorded.
Methods: As above
Results: The median age of patients was 65 years (13-89):
43% (86) female and 57% (113) male. Patients underwent
a range of procedures: cementing +/- decompression 30%
(60), decompression only 6% (11), posterior decompression
83
+ stabilisation 48% (95), anterior corpectomy 4% (7) and
anterior/posterior excision of tumour and stabilisation 13%
(26). The Frankel score improved or remained the same in
the majority of patients (91%); pain and quality of life scores
improved significantly (p=0.001). The overall complication
rate was 27% (53/199); median survival 270 days (12-2010)
with 22% (44) alive at 2 years follow-up.
Conclusions: This is perhaps the largest study of a
prospective group of patients from a single institution
undergoing surgery for spinal metastases. Surgical
treatment for spinal metastases improves pain and health
related quality of life.
Podium Presentations
Society for Back Pain Research (SBPR)
(44) 09.00-09.10
Lumbar spine CT-based fractal analysis may help in
detecting decreased quality of bone prior to urgent
spinal procedures (novel technique)
Main Author: Marcin Czyz
Co Authors: Kamil Eyvazov, Hesham Radwan, Bronek M
Boszczyk
Affiliation: Centre for Spinal Studies and Surgery, D
Floor, West Block, Queen’s Medical Centre, Derby Road,
Nottingham NG7 2UH
Conflicts of Interest: None
Funding Sources: The Kosciuszko Foundation
Background Context: To date no reliable method is
available determining parameters of bone density based
on a standard CT imaging in the emergency setup. Fractals
are mathematical sets used to describe the complexity of
objects and images and have been already used in studies
of trabecular bone structure.
Purpose: To assess the efficacy of the CT-based fractal analysis
in detecting patients with poor quality of bone prior to urgent
spinal procedures.
Study Design/Setting: Retrospective analysis
Patient Sample: The group 15 patients (total of 45 vertebrae)
in whom the DEXA scan and lumbar spine CT was performed at
an interval of no more than three months.
Outcome Measures:
Methods: Diagnostic axial CT scans of L2, L3 and L4 vertebrae
were processed to determine the fractal dimension (FD) of the
trabecular structure of each spinal level. Box-count method
and ImageJ 1.49 software were used. FD was compared to
results of the DEXA scan: bone mineral density (BMD), T-score
and Z-score.
Results: The FD was significantly higher in a group of patients
with decreased bone quality (T-score < -1.0) (P = 0.002) and
correlated with BMD (-0.55; P < 0.001), T-score (-0.52; P < 0.001)
and Z-score (-0.43; P = 0.0035). ROC curve analysis revealed
cut-of value of ED > 1.48 indicating decreased bone quality (P =
0.0002; AUC 0.77; 95%CI, 0.62-0.88).
Conclusions: Fractal analysis of the lumbar spine CT images
may be useful while determining quality of bone prior to
urgent spinal instrumentations (e.g. metastatic/traumatic cord
compression) when the DEXA scan might be hardly accessible.
Further studies of a wide prospective cohort are warranted.
BRITSPINE 2016
Friday, 8th April
(45) 09.10-09.20
(46) 09.20-09.30
Lumbar stability following graded uni- and bilateral
graded facetectomy - A finite element model study
Is there a correlation between gross motor function
classification system (GMFCS) level and scoliosis in
patients with cerebral palsy? A systematic review
Main Author: Sashin Ahuja
Co Authors: Abdul Gaffar Dudhniwala, A Tsouknidas, S
Sarrigiannidis, N Michailidis
Affiliation: Welsh Centre for Spinal Surgery & Trauma,
University Hospital of Wales; Department of Mechanical
Engineering, Aristotle University of Thessaloniki,
Thessaloniki, Greece
Conflicts of Interest: No conflicts of interest
Funding Sources: Acknowledgements: BETA CAE Systems
SA for providing with the CAE preprocessor ANSA and the
General Secretariat for Research and Technology of Greece as
part of this investigation was funded under the postdoctoral
research grant PE8(3227).
Background Context: Excessive facet joint excision during
Lumbar decompression can cause segmental instability.
Purpose: To assess segmental instability following graded
facetectomy.
Study Design/Setting: This biomechanical study was
performed using L3-S1 finite element model.
Patient Sample: Verified and validated L3-S1 finite element
model.
Outcome Measures: The effect of progressive graded
decompression of L4-L5 on the mobility, facet loading and
intradiscal pressure.
Methods: Nine scenarios were analysed. Intact model
as control, facetectomy 30 %, 45%, 60 % and uni- and bilaterally complete facet excision.
Results: Compared with control 30% excision of the facet
joint mainly caused increase in mediolateral mobility. With
45% excision of the facet joint there was increase in AP and
mediolateral mobility which was worse in bilateral and
unilateral models respectively. This worsened with larger
facet excision scenarios. Facet load increased significantly on
extension with excision of 45% & 60% unilaterally and 100%
bilaterally. Flexion produced rise in intradiscal pressure in all
scenarios.
Discussion: The increase in mediolateral motion with
unilateral facet excision might be due to balancing effect of
the paraspinal musculature under loading of uneven surface
of the facet, which probably might lead to accelerated facet
degeneration. Increased intradiscal pressure with larger
excision can lead to accelerated disc degeneration.
Conclusions: The increased spinal mobility, facet loading
and intradiscal pressure with more than 30 % facetectomy
highlights the importance of preserving facets during
decompression. These findings could potentially explain
accelerated degeneration of these segments. With 230
% increase in mobility in the sagittal plane from bilateral
facetectomy the risk of instability and spondylolisthesis is
substantiated.
BRITSPINE 2016
Main Author: Lara E McMillan
Co Authors: Abdul Gaffar Dudhniwala, Sashin Ahuja
Affiliation: Welsh Centre for Spinal Surgery & Trauma,
Trauma and Orthopaedics Directorate, University Hospital
of Wales, Cardiff CF14 4XW
Conflicts of Interest: None
Funding Sources: N/A
Background Context: Gross motor function classification
system (GMFCS) is now an established standardized
assessment tool used to classify cerebral palsy (CP) children
to levels I-V according to their gross motor function skills.
Studies predating GMFCS have shown scoliosis prevalence to
be associated with poor motor function. Prevalence of other
secondary musculoskeletal complications is associated with
increased GMFCS level.
Purpose: Determine evidence for correlation between
GMFCS level and scoliosis in CP patients. Assess possible
benefit of using GMFCS levels to identify those most at-risk
of developing scoliosis and its rapid or severe progression.
Study Design/Setting: Systematic review
Patient Sample: 5 original publications
Outcome Measures: Scoliosis incidence, prevalence and
progression
Methods: Publications sourced using Full text journals,
EMBASE, Ovid Medline, JSTOR, SCOPUS and Web of Science
search for all years of terms/subject headings: ‘gross motor
function classification system’ or ‘GMFCS’, and ‘scoliosis’.
Results: GMFCS level is a determinant of scoliosis amongst
CP young adults; higher GMFCS III-V was related to increased
scoliosis prevalence. GMFCS IV-V CP children had increased
overall scoliosis risk and moderate or severe curves. Scoliosis
progression rate and severity increased with GMFCS level
and with non-ambulation.
Conclusions: GMFCS IV-V CP children should receive greatest
spine-surveillance to monitor scoliosis emergence and
progression in order to provide early interventions if necessary,
thereby avoiding risks associated with treating high-grade
curves. Conversely, monitoring with fewer radiographs could
be adopted amongst patients with lower GMFCS as they are
less likely to develop scoliosis or experience rapid or severe
curve progression thereby reducing radiation exposure and
avoiding surveillance clinic visit.
84
Friday, 8th April
MILIF in patients with spinal stenosis?
(47) 09.30-09.40
The influence of BMI and age on the outcomes of
minimally invasive lumbar interbody fusion (MILIF) in
the surgical treatment of lumbar degenerative disorders
(DLD) – A multi-centre subgroup analysis study
Main Author: Khai Lam
Co Authors: Erlick Pereira, Neil Manson
Affiliation: Guys and St Thomas NHS Hospitals, Great Maze
Pond London SE1 9RT
Conflicts of Interest: Neil Manson Consultant for Medtronic
Canada
Funding Sources: Medtronic
Background Context:
Purpose: 12 month subgroup analysis study on influence of
Age and BMI on outcomes following MILIF (NCT01143324)
Study Design/Setting: Multicenter prospective
observational
Patient Sample: 252
Outcome Measures: Demographics, complications, time to
first ambulation (TFA), time to post-surgical recovery (TPSR),
adverse events (AEs), VAS back/leg, ODI, EQ-5D
Methods: 19 centers/14 countries, treated 1-level (83%) or
2-level (17%) MILIF. Changes from baseline [all variables:
medians/interquartile ranges (IQR), Mann-Whitney U-test].
Age groups (≤50yrs: N=102; 51-64yrs: N=102; ≥65yrs: N=48)
and Weight classes (min BMI < 25.0: N=79; 25.1 – 29.9:
N=104; > 30.0 max: N=69).
Results: All subgroups showed significant improvement on
all patient-reported-outcomes (PROs) from baseline to 12m
(p<0.0001). TFA similar for all subgroups [age groups: 1.0
(1.0)/1.0 (1.0)/1.0 (0.5) p=0.8707; weight classes: 1.0 (1.0)/1.0
(1.0)/1.0 (0.0) p=0.1013)]. TPSR greater for older and heavier
patients [age groups: 2.0 (1.0)/2.0 (2.0)/3.0 (3.0) p=0.0662;
weight classes: 2.0 (1.0)/3.0 (2.0)/3.0 (3.0) p=0.1591)] with
significant linear relationship between TPSR/age (p=0.0028)
and TPSR/weight (p=0.0024). ODI, VAS back/leg pain, EQ5D
similar in all subgroups at every time point.
Conclusions: Older, heavier and older heavier patients need
more time to recover from MILIF surgery, however additional
time needed on average remains acceptably below 24hrs.
MILIF approach for spine surgery offers good results in all age
groups and weight classes with no significant differences in
clinical endpoints between subgroups.
(48) 09.40-09.50
Do outcomes vary following minimally invasive
lumbar fusion (MILIF) in patients with spinal
stenosis? A multi-centre subgroup analysis study
Main Author: Khai Lam
Co Authors: Alaa Al-Mousa, Neil Manson
Affiliation: Guys and St Thomas NHS Hospitals, Great Maze
Pond London SE1 9RT
Conflicts of Interest: Nil
Funding Sources: Medtronic
Background Context: Determine if outcomes vary following
85
Purpose: 12 month study on influence of stenosis on MILIF in
Degenerative Lumbar Disorders (DLD) (NCT01143324).
Study Design/Setting: Multicenter prospective observational
Patient Sample: 252
Outcome Measures: Demographics, complications, time to
first ambulation (TPA), time to post-surgical recovery (TPSR),
adverse events (AEs), VAS back/leg, ODI, EQ-5D
Methods: 19 centers, 14 countries, treated 1-level (1L) (83%) or
2-level (2L) (17%) MILIF. Changes from baseline [all variables:
medians/interquartile ranges (IQR), Mann-Whitney U-test]
compared: Stenosis (S) vs Non Stenosis (NS) (N=180 vs N=72);
Stenosis Decompression (D) vs Stenosis Indirect decompression
(ID) (N=142 vs N=8).
Results: TFA similar for all subgroups [S/NS 1.0 (0.5)/1.0 (1.0)
p=0.0702; S+D/S+ID 1.0 (0.0)/1.0 (1.0) p=0.9473)]. TPSR higher
for S vs NS [3.0 (2.5)/2.0 (1.0) p=0.0021] and lower for S+D vs
D+ID [2.0 (2.0)/4.0 (3.0) p=0.0017)]. At baseline, VAS leg pain
significantly higher in S vs NS [7.0 (3.0)/5.0 (4.0) p=0.0014 but
similar 4w [2.0 (5.0)/1.0 (4.0) p=0.3805] and 12m, [1.0 (4.0)/1.0
(5.0) p=0.6425]. ODI improved slightly (n.s.) in S vs NS; VAS back
pain was equal in groups. VAS leg pain, ODI, VAS back pain pre/
post-surgery as well as changes from baseline were similar in D
compared to ID.
Conclusions: Stenosis patients need longer time for surgery
recovery, present more leg pain at baseline but better
improvement after MILIF. Non-stenosis patients present similar
outcomes 4w and 12m. Decompressed patients recover sooner
from surgery than indirectly decompressed.
(49) 09.50-10.00
A cost utility comparison of transforaminal
endoscopic discectomy and microdiscectomy
Main Author: Chloe E H Scott
Co Authors: J N Alastair Gibson
Affiliation: The Royal Infirmary and University of Edinburgh,
Little France, Edinburgh EH16 4SU
Conflicts of Interest: J N Alastair Gibson - payments for
teaching from joimax GmbH
Funding Sources: Nil
Background Context: Costs for Transforaminal Endoscopic
Spinal Surgery (TESS) must lie within acceptable limits.
Purpose: To evaluate the cost-effectiveness of discectomy
by TESS relative to microdiscectomy (Micro) from cost/
benefit ratios expressed as a utility measure.
Study Design/Setting:
Patient Sample: 140 patients aged 25-55 years and <100kg
with single-level primary lumbar disc prolapse were
randomly allocated to TESS or Micro.
Outcome Measures: ODI, SF-36, VAS scores and hospital
(BUPA UK) costs were collected. QALY gain over 1yr was
calculated from change in SF-6D scores and Scottish life
expectancy.
Methods:
Results: Procedure times were similar (63±14 vs 53±22 mins;
N.S.). Mean bed stay was lower in the TESS group (0.7±0.7
vs. 1.5±1.1 days; p<0.001). Both treatments improved pain,
BRITSPINE 2016
Friday, 8th April
disability and quality of life at 3, 12 and 24 months postsurgery (p<0.01). At 2yr, ODI was 10% lower after TESS (16.5
± 15.0 vs 24.9 ± 20.2; means ± SD; p<0.02). Return to work
rates were similar. Mean incremental cost of TESS was £6754
per patient and incremental QALY gain 6.24 years compared
with £7606 and 5.72 years for Micro (excluding equipment
costs; including 6 and 2 revision costs respectively; NS).
Lifetime cost per QALY gain was £1083 for TESS and £1329
for Micro. Discounting QALYs at 3.5% per year to reflect
diminishing gain with time, cost per QALY gain was £1360
less after TESS (£4481 Vs £5841).
Conclusions: The lower cost of TESS was slightly offset
by a higher revision rate but was an equally cost-effective
treatment. Both treatments were <£40,000 per QALY gain,
the generally accepted level for a cost effective treatment.
10.00-10.30
KEYNOTE LECTURE
What is New in Spinal Infections?
Shanmuganathan Rajasekaran (India)
Spinal infections are a challenging problem in any surgical
practice. Wound infection rates have been quoted from 2.8 to
11% and account for the most frequent reason for unplanned
early hospital re-admissions. The estimated cost for infection
related re-admissions are pegged at 17.6 billion dollars in the
USA alone.
Primary pyogenic and tuberculosis spondylitis are also on the
increase in most parts of the world. The scenario is compounded
by increasing antibiotic resistance which results in 2 million
illness and an increase in direct health care costs by 20 billion
dollars and another 25 billion $ in indirect costs (CDC, 2008).
This lecture will deal with what is new in the diagnosis and
management of various spinal infections.
Podium Presentations
British Association of Spine Surgeons (BASS)/
British Scoliosis Society (BSS)
Trauma/Tumour
(50) 11.00-11.10
Comparison of segmental pedicle screws versus
hybrid constructs using sublaminar wires for
deformity correction in cerebral palsy
Main Author: Luigi Aurelio Nasto
Co Authors: A B Perez-Romera, A Kapinas, S Muquit, H
Mehdian
Affiliation: Queen’s Medical Centre, Spinal Unit, Nottingham
Conflicts of Interest: No conflicts of interest
Funding Sources: University of Nottingham
Background Context: Correction of spinal deformity
in cerebral palsy patients is challenging. Historically,
sublaminar wire fixation methods have been used but more
recently segmental pedicle screw fixation has increased in
popularity among spinal surgeons.
BRITSPINE 2016
Purpose: To compare surgical outcomes of CP patients
treated with sublaminar wires and all pedicle screws fixation
constructs.
Study Design/Setting: Prospectively enrolled consecutive
series of spastic quadriplegic cerebral palsy patients.
Patient Sample: 48 GMFCS IV and V CP patients.
Outcome Measures: Radiological and surgical outcome
measures.
Methods: 28 male and 20 female spastic quadriplegic
cerebral palsy patients, age of 16-years (11-25) underwent
correction for spinal deformity. Group I (25 patients) were
treated with segmental pedicle screw constructs and in
Group II (23 patients) received hybrid constructs. Mean postoperative follow up was 4.8 years (2-13).
Results: Instrumentation was from T2 to pelvis in all patients.
In group I, preoperatively the coronal plane deformity
measured 79°, thoracic kyphosis 68°, lumbar lordosis 43°,
pelvic obliquity 19° and there was 32mm coronal shift.
Corresponding measures in group 2: 75°, 65°, 40°, 18° and
33mm. Postoperatively these measures of deformity in
group 1 were: 10°, 40°, 49°, 2° and 2mm. In group 2: 24°,
44°, 55°, 7°, and 10mm. The surgical time was 40min longer
in group 2 and there was a 10% increase in implant failure
and junctional kyphosis and 16% failure of maintenance of
correction.
Conclusions: The magnitude and maintenance of correction
of spinal deformity of in spastic quadriplegic cerebral palsy
patients is better with segmental pedicle screw constructs
than hybrid constructs, with reduced complication rates.
(51) 11.10-11.20
Posterior instrumented fusion for thoracolumbar
kyphosis in mucopolysaccharidoses type 1
Main Author: Neil Oxborrow
Co Authors: Thomas Finnigan, Ian McLaughlin, Simon
Hughes
Affiliation: Royal Manchester Children’s Hospital
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Management of this condition is
not well represented in the literature. Isolated reports on
the surgical management of this disorder appear. It has
previously been thought that posterior only fixation is not
appropriate in this cohort of patients.
Purpose: To describe a new technique for treating
progressive thoracolumbar kyphosis in children with
mucopolysaccharidosis.
Study Design/Setting: A case series of seven
children who had a thoracolumbar gibbus related
to mucopolysaccharidosis treated with posterior
instrumentation only were reported retrospectively.
Patient Sample: Case series of seven patients.
Outcome Measures: Imaging (Kyphosis correction (cobb
angle)), complications, revision surgery.
Methods: Seven patients underwent posterior
instrumentation for correction of a thoracolumbar
kyphosis. Preoperative kyphosis ranged from 48° to 79°
(average, 63.7°). Data on all seven patients were collected
86
Friday, 8th April
prospectively. The technique and its principles are
described.
Results: A good correction of the kyphosis was obtained,
with postoperative angles of 13° to 39° (average, 24.6°), and
maintained through the follow-up period. There were no
complications from the procedure.
Conclusions: Posterior instrumented correction and fusion
of the spine is safe and effective in treating thoracolumbar
kyphosis associated with mucopolysaccharidosis.
(52) 11.20-11.30
Effects of frequency of distraction in magneticallycontrolled growing rod lengthening on outcomes
and complications
Main Author: Behrooz Akbarnia
Co Authors: Kenneth Cheung, Kenny Kwan, Dino Samartzis,
Ahmet Alanay, John Ferguson, Chrishan Thakar, Pavlos
Panteliadis, Colin Nnadi, Ilkka Helenius, Muharrem Yazici,
Gokhan Halil Demirkiran
Affiliation: San Diego Center for Spinal Disorders, La Jolla,
California; USA
Conflicts of Interest: None to declare
Funding Sources: Ellipse Technology
Background Context: The ideal frequency of MCGR
distraction is currently not known.
Purpose: This study aimed to determine the effects of
distraction frequencies on implant-related complications
and re-operations.
Study Design/Setting: Retrospective multicentre study
with a minimum 2 year follow up
Patient Sample: Consecutive patients with EOS undergoing
MCGR treatment
Outcome Measures: Clinical and Radiological
Methods: Retrospective review of prospectively collected
data from consecutive patients undergoing MCGR treatment
with minimum 2-year follow-up from 6 centres.
Results: Thirty patients were included in this study. The
mean age at the time of surgery was 7.3 years (range: 4 to
14 years) and the mean follow-up period was 35 months
(range: 24 to 61 months). Patients were divided into 2 groups
according to their distraction frequency: Group 1 (every 1
week-2 months), and Group 2 (every 3 to 6 months). There
were 14 patients in Group 1, and 16 in Group 2. Patients
in Group 1 had more re-operations due to failure of rod
distraction (71% vs 25%) and a higher incidence of PJK (21%
vs 13%) than Group 2. However, there were fewer incidences
of implant-related complications including rod breakage
and proximal foundation failure (14% vs 31%) in Group 1
compared with Group 2.
Conclusions: Our study showed more frequent distractions
were associated with increased incidence of rod distraction
failure and PJK but lower incidence of implant-related
complication. Clinicians should be aware of a potential
higher risk for re-operation if the interval between each
distraction is less than 3 months.
87
(53) 11.30-11.40
Computational models for characterization and
design of patient-specific spinal implant
Main Author: Claudio Capelli
Co Authors: Tiziano Serra, Deepak Kalaskar, Julian Leong
Affiliation: University College London, The Royal National
Orthopaedic Hospital
Conflicts of Interest: no conflicts of interest
Funding Sources: EPSRC
Centre for Innovative
Manufacturing in Medical Devices MeDe
Background Context: Spinal fusion is designed to reduce
movements between vertebrae and therefore pain. The most
used devices for this procedure are mainly made of titanium
or polyether ether ketone (PEEK). However, the mismatch
between devices, with standard shapes and materials, and
the surrounding bones can lead to sub-optimal outcomes.
Computational models, namely Finite Element Analyses
(FEA), can be employed to optimize existing device and
design more effective solutions.
Purpose: The goal of this study was to compare the
performance of different materials and material densities
for spinal cages, and to design a novel geometry which can
ideally match the anatomical characteristics of a patient.
Study Design/Setting: Computational
Patient Sample:
Outcome Measures:
Methods: FEA were set up to simulate compression (400N)
and bending (7.5Nm) on a generic cage design. Three
materials were modelled: titanium, PEEK and polycarbonate.
Polycarbonate was included as widely available within
additive manufacturing techniques. For each of the cages,
four designs were modelled with varying material filling
density. Furthermore, a new cage was modelled to match
the preoperative CT of a patient exactly. The patient-specific
cage was also tested by means of FEA.
Results: Stress distribution was compared between all the
three materials tested. Consistently, stresses increased with
reducing material density. Stress peak values were lower
than the respective risk of failure in all the simulated cases,
confirming the feasibility of polycarbonate implants. The
patient-specific design showed even stress distribution
consistently within anatomical constraints.
Conclusions: Computational analyses suggested the
feasibility of a lighter, cheaper and patient-specific cage for
spinal fusion.
(54) 11.40-11.50
Metastatic spine tumour surgery: minimally invasive
approach versus open approach
Main Author: Naresh Kumar1
Co Authors: Rishi Malhotra1, Karthikeyan Maharajan1, Aye
Sandar Zaw1, Pang Hung Wu1, Milindu Makandura1, Gabriel
Liu1, Joseph Thambiah1, Hee-Kit Wong1, Aravind Kumar2
Affiliation: 1.Department of Orthopaedic Surgery, National
University Health System, Singapore, 2.Department of
Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore
Conflicts of Interest: None
BRITSPINE 2016
Friday, 8th April
Funding Sources: None
Background Context: Minimally invasive surgery (MIS) has
been known to be better than traditional open spine surgery
for treating degenerative spine conditions when comparing
the blood loss and postoperative morbidity. A number of
studies have been conducted to establish MIS in metastatic
spine disease (MSD). However, majority were case series and
a very few comparing the outcomes between MIS and open
approaches.
Purpose: To evaluate and compare the outcomes of open
and MIS approach in patients with symptomatic MSD.
Study Design/Setting: Prospective analysis
Patient Sample: 22 patients undergoing MIS & 22 patients
undergoing open surgery
Outcome Measures: Pain, Frankel score, Blood loss, Time to
initiate radiotherapy
Methods: Preoperative, intraoperative and postoperative
data were collected for direct comparison of the two
approaches. Generalized Linear Model was used to estimate
the effect of MIS on outcomes, adjusting for potential
confounders. Follow-up was a minimum period of three
months from time of surgery.
Results: There was significant difference between
preoperative and postoperative mean VAS score in both
groups. All patients showed neurological improvement
post-operatively. Frankel score E was achieved in 82% of
patients in MIS group compared to 54% in the open group.
Blood loss was significantly lower in MIS group than open
group. MIS group commenced radiotherapy 7 days earlier
than the open group. Operative time, duration of hospital
stay and time to initiate chemotherapy were also favourable
in MIS group though the difference was not statistically
significant.
Conclusions: The introduction of MIS can be a game-changer
in treatment of MSD by lowering peri-operative morbidity
and enabling earlier radiotherapy and/or chemotherapy.
(55) 11.50-12.00
Rib-sparing minimally invasive vertebrectomy
is a safe and effective treatment for single-level
metastatic spinal disease; a case series of 15
patients
Main Author: Jake Timothy
Co Authors: Jamie Wilson, Edward Rice, Mark Knights, Peter
Loughenbury
Affiliation: Department of Neurosurgery, Leeds General
Infirmary, Great George Street, Leeds, LS13EX
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Vertebrectomy is an established
means of improving pain control and mobility for singlelevel metastatic spinal disease, but is associated with
significant post-operative morbidity when performed via a
traditional thoracotomy approach.
Purpose: Description of anterior vertebrectomy via
minimally-invasive lateral approach, without rib resection.
Study Design/Setting: Technical note, case series.
Patient Sample: 15 patients with single-level metastatic
spinal disease.
BRITSPINE 2016
Outcome Measures: Self-reported pain and mobility,
length of high dependency unit (HDU) and hospital stay,
complication incidence.
Methods: A modified direct lateral approach allowed
retroperitoneal access to the anterior spine through the
intercostal space. Vertebrectomy was performed with
fluoroscopic screening, and Polyetheretherketone (PEEK)
intervertebral cage inserted. Intercostal muscles were
closed under positive respiratory inspiration, without the
placement of an intercostal drain, followed by posterior
augmentation. Case series data was collected through
retrospective electronic database analysis.
Results: 15 patients (9 male, 6 female) were identified, with postoperative pain reduction in 11 (73%) and improved mobility in 9
(60%). Pneumothorax was noted in 3 patients (20%), with chest
drainage required in only 1 (7%). Superficial wound infection
(not requiring re-operation) occurred in 1 patient (7%). 8 patients
(53%) went to HDU postoperatively, with mean length of HDU
stay 4 days. Median hospital stay was 8 days.
Conclusions: Rib-sparing minimally invasive vertebrectomy
using PEEK cages is a safe and effective method of managing
metastatic spinal disease, reducing post-operative morbidity
and inpatient stay compared to traditional operative
approaches. This technique can significantly improve quality
of life in terminal cancer patients. Future work will evaluate
economic benefit in this cohort using standardised outcome
measures.
Special Posters
(SP13) 11.00-11.05
Interbody fusion in low grade spondylolisthesis –
clinical outcome do not correlate with slip reduction
and neural foraminal dimension
Main Author: Ujjwal K Debnath
Co Authors: J R McConnell, A Chatterjee, Vivek Goel
Affiliation: Ramakrishna Mission Seva Pratisthan, 99 Sarat
Bose Road, Kolkata 700026, India
Conflicts of Interest: None
Funding Sources: None
Background Context: Beneficial effect of reduction on
outcome can be expected following reduction and fusion
for low grade lumbar spondylolisthesis but it is debatable.
Purpose: Analysis of correlation between the clinical
outcome and radiological parameters
Study Design/Setting: Prospective study
Patient Sample: Patients with low grade spondylolisthesis
who underwent TLIF
Outcome Measures: Clinical outcome was measured
by Visual Analogue Scores (VAS) and Oswestry Disability
Index (ODI),Foraminal dimensions and disc heights were
measured in standard digital radiographs
Methods: 46 patients (age 17-48years) with isthmic
spondylolisthesis underwent interbody fusion with TLIF. Pre
and one year post op outcomes were analysed.
Results: The baseline and at one year postoperative, the
mean VAS scores were 6.39 (range 5-8) and 0.81 (range
0-3) respectively (p=0.004). The baseline and at one year
88
Friday, 8th April
postoperative, the mean ODI scores were 48 (range 3458) and 9.8 (range 4-22) respectively (p<0.001). A mean
spondylolisthesis slip of 33.2% was reduced to 6.7% at 1
year. Average anterior disc height, posterior disc height,
C distance, F diameter improved from 9.4mm to 11.7mm
(p=0.005), from 4.3mm to 5.8mm (p=0.004), from11.2mm
to 12.0mm (p=0.002), from 18.5mm to 19.4mm respectively
(p<0.001). Pearson’s correlation coefficients were significant
for two radiological parameters i.e. (∆) listhesis (r=0.46,
p=0.006) & C distance (r= 0.44, p=0.01) for the improvement
in the VAS scores only. All other radiological parameters had
very low correlation with the clinical outcomes. Therefore,
no correlation could be established statistically between
the slip reduction and clinical outcome.
Conclusions: Neural decompression and interbody fusion
significantly improved pain and disability but the clinical
outcome does not correlate with radiological improvement
in neural foraminal dimension.
(SP14) 11.05-11.10
Feasibility of manufacturing a patient specific spinal
implant
Main Author: Tiziano Serra
Co Authors: Claudio Capelli, Deepak Kalaskar, Julian Leong
Affiliation: University College London, The Royal National
Orthopaedic Hospital
Conflicts of Interest: no conflicts of interest
Funding Sources: EPSRC Centre for Innovative
Manufacturing in Medical Devices MeDe
Background Context: Spinal fusion is performed for
degenerative spinal condition when conservative measures
fail. Implant size and shape are not standardised between
manufacturers, and best match often means compromises.
Bioprinting offer a unique opportunity to create a tailormade solution.
Purpose: The goal of this study was to design and
manufacture a 3D-printed lumbar cage for lumbar interbody
fusion.
Study Design/Setting: Feasibility study, laboratory based
Patient Sample:
Outcome Measures:
Methods: Previous optimization of the cage design via
computational analysis was performed. Bioprinting process
consists of a robotic tool enabling a layer-by-layer deposition
of material to reproduce the designed cage. In order to
print the cage, a low-cost 3D-printer was used. First, all the
parameters of the process (e.g. temperature, deposition
speed, filling density) were determined experimentally. Then,
assessments of morphological, structural and mechanical
properties were performed. Finally, biocompatibility was
evaluated in vitro by assessing cell morphology, adhesion,
and proliferation.
Results: Computational analysis was a powerful method
for preliminary testings of cage design and filling density.
Surface evaluation showed a unique topographical pattern
at the micro and nanoscale, and micro CT scan confirmed
structural reproducibility. Compressive tests showed
comparison mechanical properties between trabecular bone
and the printed cage. Finally, positive cell response proved
high biocompatibility of the material used. Combination of
89
optimized fabrication parameters gave a printing time of 2
hours and cost around 20p for each printed cage.
Conclusions: Bioprinting is both feasible and affordable to
offer patient specific spinal implants.
(SP15) 11.10-11.15
Clinico-radiological outcomes following
transforaminal versus lateral lumbar interbody fusion
Main Author: Fady Sedra
Co Authors: Arash Afsharpad, Benan Dala-Ali, Robert Lee,
Lester Wilson
Affiliation: Royal National Orthopaedic Hospital, Stanmore
HA7 4LP
Conflicts of Interest: No conflict of interest
Funding Sources: No funding obtained
Background Context: Lateral approach to lumbar fusion
has been gaining popularity in recent years. It utilizes a
retroperitoneal transpsoas approach to reach the disc space
in a minimally invasive fashion. It allows better access for
disc clearance and insertion of large foot print cages.
Purpose: To compare radiographic and clinical results
following lateral lumbar (LLIF) and minimally invasive
transforaminal (MI-TLIF) interbody fusion
Study Design/Setting: Retrospective review
Patient Sample: We included 60 patients operated at
82 levels, Group 1 LLIF (n=28) Group 2 MI-TLIF (n=32). We
measured radiological outcomes at L3/4 or L4/5.
Outcome Measures: Radiological: Disc height, foraminal
height, segmental lordosis, overall lumbar lordosis. Clinical
outcomes included VAS, ODI and EQ-5D
Methods: Radiological outcomes were measured on
standing lateral X-rays preoperatively, immediately
postoperatively and at the last follow up. Clinical outcomes
were recorded preoperatively, at 6-8 weeks postoperatively
and at the last follow-up.
Results: Group 1: Mean improvement in disc height
9.1mm, foraminal height 5mm, segmental lordosis 6.75o,
lumbar lordosis 15.4o, ODI 37, VAS 56.2, EQ-5D 54. Group
2: disc height 5.8mm, foraminal height 3.5mm, segmental
lordosis 4.5o, overall lordosis 10.3, ODI 18, VAS 26, EQ-5D
23.5. Difference in parameters was statistically significant
(p<0.05) apart from ODI.
Conclusions: Cages inserted via the lateral approach have
the ability to improve lumbar/segmental lordosis and is
superior in restoring disc and foraminal height compared to
MI-TLIF. Patients in the LLIF group showed improved clinical
outcomes compared to the MI-TLIF group.
(SP15) 11.10-11.15
Clinico-radiological outcomes following
transforaminal versus lateral lumbar interbody fusion
Main Author: Fady Sedra
Co Authors: Arash Afsharpad, Benan Dala-Ali, Robert Lee,
Lester Wilson
Affiliation: Royal National Orthopaedic Hospital, Stanmore
HA7 4LP
Conflicts of Interest: No conflict of interest
BRITSPINE 2016
Friday, 8th April
Funding Sources: No funding obtained
Background Context: Lateral approach to lumbar fusion
has been gaining popularity in recent years. It utilizes a
retroperitoneal transpsoas approach to reach the disc space
in a minimally invasive fashion. It allows better access for
disc clearance and insertion of large foot print cages.
Purpose: To compare radiographic and clinical results
following lateral lumbar (LLIF) and minimally invasive
transforaminal (MI-TLIF) interbody fusion
Study Design/Setting: Retrospective review
Patient Sample: We included 60 patients operated at
82 levels, Group 1 LLIF (n=28) Group 2 MI-TLIF (n=32).
We measured radiological outcomes at L3/4 or L4/5.
Outcome Measures: Radiological: Disc height, foraminal
height, segmental lordosis, overall lumbar lordosis. Clinical
outcomes included VAS, ODI and EQ-5D
Methods: Radiological outcomes were measured on
standing lateral X-rays preoperatively, immediately
postoperatively and at the last follow up. Clinical outcomes
were recorded preoperatively, at 6-8 weeks postoperatively
and at the last follow-up.
Results: Group 1: Mean improvement in disc height
9.1mm, foraminal height 5mm, segmental lordosis 6.75o,
lumbar lordosis 15.4o, ODI 37, VAS 56.2, EQ-5D 54. Group
2: disc height 5.8mm, foraminal height 3.5mm, segmental
lordosis 4.5o, overall lordosis 10.3, ODI 18, VAS 26, EQ-5D
23.5. Difference in parameters was statistically significant
(p<0.05) apart from ODI.
Conclusions: Cages inserted via the lateral approach have
the ability to improve lumbar/segmental lordosis and is
superior in restoring disc and foraminal height compared to
MI-TLIF. Patients in the LLIF group showed improved clinical
outcomes compared to the MI-TLIF group.
(SP16) 11.15-11.20
The 3 year effects of a four-week intensive scoliosisspecific physiotherapy (SSP) programme on
patient-reported quality of life (QoL) in adults with
idiopathic scoliosis (IS)
Main Author: Erika Maude
Co Authors: Michael Bradley, Jason Black, Christine Pilcher,
David Glynn
Affiliation: Scoliosis SOS, London
Conflicts of Interest: Erika Maude, Michael Bradley, Jason
Black, Christine Pilcher - employed by Scoliosis SOS; David
Glynn - none
Funding Sources: None
Background Context: Health-related QoL is often reduced
in scoliotic patients; therefore it is essential for any
treatment methods to address this.
Purpose: To investigate whether SSP improves patientreported QoL in IS patients.
Study Design/Setting: An observational case series within
a private physiotherapy clinic.
Patient Sample: 731 adult patients with IS (mean age
33yrs, range 18-64, SD 14.68) treated with a four-week
intensive course of SSP (ScolioGold) between 2006-2013.
Outcome Measures: Scoliosis Research Society-30 (SRS-30)
questionnaire
BRITSPINE 2016
Methods: All patients rated their QoL pre-treatment,
post-treatment, and at all subsequent time-points using a
modified version of SRS-30.
Results: In the cohort analysed pre- and post-treatment
(n=512), mean total SRS-30 score increased from 3.19
(SD 0.58) to 3.60 (SD 0.47). For the cohort analysed pretreatment and at >3 years (n=64), SRS-30 score increased
from 3.23 (SD 0.58) to 3.69 (SD 0.44). Statistically significant
increases in QoL were found at all time-points at all time
points investigated pre- and post-treatment, 1yr, 3yrs, >3yrs
(p = <0.05).
Conclusions: These results show the positive effect of
ScolioGold on adult patients’ QoL and add to the growing
evidence for SSP.
(SP17) 11.20-11.25
Improvement in unfused adjacent segment disc
condition following posterior spine fusion for
adolescent idiopathic scoliosis
Main Author: Wai Weng Yoon
Co Authors: Anum Awais, Nicole Williams, Michael Derrick
Selby
Affiliation: Queen’s Medical Centre, Nottingham/Women
and Children’s Hospital, Adelaide, Australia
Conflicts of Interest: None
Funding Sources: None
Background Context: One of the key questions asked by
scoliosis surgeons and patients following surgery is the
impact of the long lever arm on adjacent segment discs. It
has been a long held belief that adjacent segments suffer
from higher stresses imparted on them due to a long fused
segment. Although studies exist demonstrating no increase
in adjacent segment degeneration this is the first prospective
study to look at both anterior and posterior instrumented
fusions in a single centre series.
Purpose: The purpose of this study was to assess the longterm radiological changes in MRI at the caudal un-fused
adjacent segments following AIS surgery.
Study Design/Setting: Prospective cohort study
Patient Sample: 30 patients
Outcome Measures: MRI scan looking at change in
Pfirrmann grade
Methods: Patients having AIS surgery were offered inclusion
into this ethically approved (HREC/13/WCH/104) trial and
were between 3 and 7 years (Y) post-surgery. Any patients
with prominent syrinx, scoliosis related syndromes or
neuromuscular diseases were excluded. All patients had
preoperative MRI scans and were brought back for re-scanning
postoperatively at a mean follow up period of 5.3 Y (3-7.5 Y).
The MRI scans were reviewed by an independent attending
using the Pfirrmann classification system. Wilcoxon matched
pairs signed rank tests were used to evaluate the scores of the
pre and post-operative MRI discs at adjacent levels.
We identified 30 patients with a mean age of 20.4 Y (16-24
Y). There were 26 female, 4 Male. The average follow-up was
5.3 Y post-surgery (3-7.5 Y). In total, 21 Patients had posterior
instrumented fusions (median number of levels fused 12 (813)) and 9 anterior instrumented fusions (median number of
levels fused 4 (3-5)). There were a total of 133 discs below
the level of fusion that were evaluated.
90
Friday, 8th April
Results: There was no statistically significant change in
Pfirrmann grade in the cohort as a whole. In the directly
adjacent non-instrumented level there was a significant
improvement in Pfirrmann grade from a median of 2 to 1,
p=0.01. Looking closer this was evident in the posterior
instrumented cases (p=0.007) and not in the anterior cases
(NS).
Conclusions: There was no statistically significant change
in disc degeneration in the follow-up period in all the discs
analysed. However a statistically significant improvement
in Pfirrmann grade was seen in directly adjacent levels for
the posterior cases but not in the anterior. The reasons
for this are currently under investigation with further MRI
volumetric evaluation.
(SP18) 11.25-11.30
Sagittal alignment of the cervical spine following
correction of Scheuermann’s kyphosis
Main Author: Luigi Aurelio Nasto
Co Authors: A B Perez-Romera, S T Shalabi, S Muquit, H
Mehdian
Affiliation: Queen’s Medical Centre, Spinal Unit, Nottingham
Conflicts of Interest: No conflicts of interest
Funding Sources: University of Nottingham
Background Context: Data on sagittal alignment of the
cervical spine in SK before and after surgical correction are
sparse if not missing at all.
Purpose: This study is the first to investigate the sagittal
alignment of the cervical spine in SK following correction.
Study Design/Setting: Retrospective case series
Patient Sample: 47 SK patients
Outcome Measures: 15 radiographic parameters
Methods: This is a retrospective review of 47 patients
surgically treated for SK and 33 healthy controls. Patients
were divided into two groups according to the kyphosis apex
level; Type 1 (apex T4-T9, n=33) and Type II (apex T10-T12,
n=14). Mean age was 17.9 (17-25). The average follow-up
was 4.0 (2.3–9.2) years. Radiographic measurements were
made preoperatively, 3 months postoperatively, and at final
follow-up.
Results: Demographics and thoracic kyphosis magnitude
were not significantly different between both SK groups.
Preoperative cervical lordosis (CL) was hyperlordotic in
Type I (21.3°±10.5°) and significantly less lordotic in Type II
(6.0°±5.1°). At final follow up, CL was restored to be within
the normal range in both groups, (Type I 18.5°±8.5° and Type
II 12.2°±3.8°). T1 slope angle was the single most important
regional parameter in determining post-operative changes
in c-spine sagittal alignment.
Conclusions: Our data demonstrates that the cervical spine
in SK is hyperlordotic in Type I and hypolordotic in Type II.
Following thoracic correction, CL was restored within the
normal range in this age group regardless of the type of
the deformity. However, at the early follow-up a significant
decrease of cervical lordosis was noted.
91
(SP19) 11.30-11.35
Reduction of high grade spondylolisthesis through
a posterior approach and restoration of the pelvic
parameters
Main Author: Shrijit Panikkar
Co Authors: Silviu Sabou, Irfan Siddique, Rajat Verma, Saeed
Mohammad
Affiliation: Spinal Unit, Salford Royal NHS Foundation Trust,
Stott Lane, Manchester M6 8HD
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: High grade spondylolisthesis presents
a significant surgical challenge and traditionally surgery has
ranged from in situ fixation to major reconstructive surgery
with high rates of morbidity.
Purpose: To present the efficacy and safety of a novel
technique in the surgical management of high grade
spondylolisthesis.
Study Design/Setting: Retrospective analysis of a case
series of patients who underwent this procedure over a five
year period.
Patient Sample: 9 patients with Meyerding Grade III, IV and
V listhesis at L5/S1
Outcome Measures: Peri- and post-operative complications,
radiographic outcome (listhesis correction, kyphosis
correction, sagittal balance and pelvic parameters), clinical
outcome (COMI scores)
Methods: All patients underwent surgery through a posterioronly approach from 2010 to 2015. The technique is described
is undertaken with pedicle screw instrumentation at L5 and S1
and a 360 degree release from posterior approach. A gradual
reduction was undertaken with continuous EMG monitoring
with interbody fusion of the affected segment.
Results: A near complete reduction to Grade 1 or 2 was
achieved in all cases, with satisfactory post-operative
radiographic parameters. No patients had a post-op
neurological deficit. Two patients had unilateral L5
hyperaesthesia which settled between six and twelve
weeks. All patients showed improvement in their back pain,
improved pelvic parameters and patient satisfaction.
Conclusions: We have demonstrated satisfactory outcomes
in the reduction of high grade lumbar spondylolisthesis
using a novel posterior-only technique with low morbidity
and satisfactory radiographic and clinical outcomes.
(SP20) 11.35-11.40
Perioperative complications of pedicle subtraction
osteotomy
Main Author: Prokopis Annis
Co Authors: Sujay Dheerendra, Michael Daubs, Darrel
Brodke
Affiliation: Royal Liverpool University Hospital, University of
Nevada, University of Utah (USA)
Conflicts of Interest: Darrel Brodke: Consultant Amedica,
Medtronic, Michael Daubs: consultant Depuy Synthes
Funding Sources: None
BRITSPINE 2016
Friday, 8th April
Background Context: Pedicle subtraction osteotomies
(PSO) are now more commonly performed to address a
number of pathologies resulting in sagittal imbalance. The
complications and outcomes of this complex procedure
have mainly been reported from a few major centers that
were instrumental in teaching and perfecting the technique.
The purpose of our study was to describe the perioperative
complications (0-90 days) associated with PSO’s.
Purpose: Describe the perioperative complications (0-90
days) after pedicle subtraction osteotomy in lumbar spine.
Study Design/Setting: Retrospective review series
Patient Sample: 65 consecutive patients
Outcome Measures: Radiographic/chart review
Methods: 65 patients were evaluated, with a mean age of 60
years. Our descriptive data and analysis of complications was
limited to the perioperative time within 90 days of surgery.
Data analysed included: OR time, length of stay (LOS), EBL,
blood products, comorbidities, neurologic complications,
and medical complications. Complications were analysed as
major and minor. Radiographic data was also analysed.
Results: The PSO was performed at L1(2), L2(18), L3(34),
L4(9), and L5(2). The mean sagittal C7 plumb line improved
from 118mm to 53mm. The mean OR time was 438 minutes
(r 256-768), mean EBL 2371 cc (r 450-9000), mean LOS
7.6 days (r 3-24), mean ICU stay 1 day , and mean patient
comorbidities 1.78(r 0-5). Ten patients (15.4%) had a major
complication, and 15 (23%) had a minor complication. There
were 3 perioperative deaths. The most common major
complication was neurologic deficit 4.6% (4/65), 3 with a
permanent foot drop, and one with paraplegia secondary to
postoperative hematoma.
Conclusions: The major complication rate 15% and the
minor complication rate was 23%. The most common major
complication was neurologic deficit 4.6%. The complication
rate did not change with increased surgeon experience.
(SP21) 11.40-11.45
Predictive factors for APJF after adult deformity
surgery: a multivariate analysis
Main Author: Prokopis Annis
Co Authors: Darrel Brodke
Affiliation: Royal Liverpool University Hospital; University of
Utah (USA)
Conflicts of Interest: Darrel Brodke (Consultant Amedica,
Medtronic)
Funding Sources: None
Background Context: Acute Proximal Junctional Failure
(APJF), was recently defined as: postoperative fracture of the
upper instrumented vertebrae (UIV) or UIV+1; UIV implant
failure; proximal junctional kyphosis (PJK) increase >15°; or
need for proximal extension of the fusion within 6 months
of surgery.
Purpose: Assess revision rates and timing following
APJF, and to identify independent predictive factors by
multivariate analysis.
Study Design/Setting: Retrospective review series
Patient Sample: 135 consecutive patients
Outcome Measures: Radiographic
Methods: A retrospective review was conducted of 135
BRITSPINE 2016
consecutive adult deformity patients with minimum 2-year
follow up, all with UIV in the TL spine (T9-L2). Fusions were
divided into 3 cohorts based on the UIV location (T9-T10 vs
T11-T12 vs L1-L2). Incidence and failure modes of APJF, as well
as timing are reported. Risk factors for APJF were assessed
with univariate and multivariate regression analysis models.
Results: 135 consecutive patients were reviewed, with
mean follow-up 42 months (24-126). Mean age was 66
years (24-86). The incidence of APJF was 38.5%, with a trend
towards higher APJF failure in the T9-T10 group (p=0.07).
Multivariate regression analysis confirmed postoperative
PJA >5°, and greater correction of LL are independent risk
factors for APJF.
Conclusions: The incidence of acute proximal junctional
failure in adult deformity patients is higher than previous
reported if the UIV is in the lower thoracic and lumbar spine.
Fracture at the UIV or UIV+1 lead to the highest revision
rate, while PJK >15° had the longest revision-free survival.
Postoperative PJA >5° and greater correction of LL are
independent risk factors for APJF.
(SP22) 11.45-11.50
The fate of L5-S1 with low dose BMP-2 and pelvic
fixation in adult deformity surgery
Main Author: Prokopis Annis
Co Authors: Darrel Brodke
Affiliation: Royal Liverpool University Hospital, University of
Utah (USA)
Conflicts of Interest: Darrel Brodke (Consultant Amedica,
Medtronic)
Funding Sources: None
Background Context: Pseudarthrosis at the L5-S1 level
is one of the most common complications of long fusions
to the sacrum in adult deformity patients. Strategies for
decreasing non-union rates, supported from clinical and
biomechanical data, include interbody fusion and cage, use
of high-dose BMP at the lumbo-sacral junction, and the use
of sacro-pelvic fixation.
Purpose: Was to evaluate L5-S1 fusion success after adult
deformity surgery with pelvic fixation and low dose BMP-2,
with or without interbody fusion.
Study Design/Setting: Retrospective review series
Patient Sample: 61 consecutive patients
Outcome Measures: Radiographic
Methods: A retrospective review was conducted of 61
consecutive patients with minimum 2-year follow-up,
treated operatively for adult spinal deformity. The patients
were divided in 2 cohorts for comparison based on the use
of interbody cage at L5-S1 level. Radiographic union was
assessed using Bridwell criteria. Revision rates and implant
related complications were also reported.
Results: There were 35 patients in the interbody group, 26
in the no interbody group. In both groups a mean of 3.5mg
(2-4 mg) was used postero-laterally with allograft and local
autograft. The mean amount of BMP-2 inserted in the disc
space was 2.5mg (0-8 mg). Fusion rate at L5-S1 was found to
be 97% with no difference between the interbody and noninterbody groups. The overall revision rate for L5-S1 nonunion was 1.6%.
Conclusions: The use of low dose of BMP-2 at the L5-S1 level
92
Friday, 8th April
in combination with sacro-pelvic fixation achieved satisfactory
outcomes in adult deformity surgery. No additional benefit
was achieved by adding an interbody fusion when low dose
BMP-2 and sacro-pelvic fixation were used.
(SP23) 11.50-11.55
Medium term outcome of posterior surgery in
the treatment of non-tuberculous bacterial spinal
infection
Main Author: Aljawadi Ahmed
Co Authors: Elmajee Mohammed, Imo Eze, Sethi Gagan,
Arnall Frances, Choudhry Muhammad Naghman,
George Kuriakose Joshi, Tambe Anant, Verma Rajat, Yasin
Mohammed Naveed, Mohammed Saeed, Siddique Irfan
Affiliation: Salford Royal NHS Foundation Trust, Manchester
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Posterior surgery without
debridement is one of the management lines for
nontuberculous de novo spinal infection
Purpose: to evaluate the Medium-term outcome after
posterior stabilization surgery for the management of nontuberculous bacterial spinal infection.
Study Design/Setting: Retrospective Cohort Study
Patient Sample: 21 Patients
Outcome Measures: Frankel Grading System (FGS), CRP,
WBC, COMI score, Euro EQ-5D format.
Methods: Patients presenting to a single tertiary referral spinal
centre between August 2011 and June 2014 were included
in the study. 21 patients with nontuberculous bacterial
infection were identified and included in the study. All
patients were managed surgically with posterior stabilisation,
with or without neural decompression, without debridement
of the infected tissue. Neurological state was assessed using
the frankel grading system before and after surgery. Longterm follow-up data was collected using SpineTango COMI
questionnaires and Euro Qol EQ-5D system with a mean
follow-up duration of 20 months postoperatively.
Results: The mean improvement in neurological deficits was
1 Frankel grade (range 0-5). At final followup, at a mean of
20 months, mean COMI score was 4.58, average VAS for back
pain was 4.28. These symptoms were having no effect or only
minor effect on the work or usual activities in 52%. 38% of
patients reported a good quality of life. The average EQ-5D
value was 0.431. There were no problems with mobility in 44%
of patients. In 72% there were no problems with self-care.
Conclusions: Our study has shown that posterior surgery
for the management of bacterial, nontuberculous
spinal infection can improve neurological outcome in
approximately half of the patients. However, at long term
followup, only around 50% of patients were able to return
their pre-morbid work or usual activities.
Co Authors: John Street, Michael Boyd, Charles Fisher,
Marcel Dvorak, Scott Paquette, Brian Kwon
Affiliation: Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore HA7 4LP; Vancouver General Hospital,
Vancouver, BC, Canada
Conflicts of Interest: No conflict of interest
Funding Sources: None
Background Context: The treatment of post-operative
deep spinal wound infection involves debridement and
intravenous antibiotics. Authors have previously reported
success in small series of patients treated with VAC therapy
but its use over exposed dura is controversial and the
outcome has not been reported in large series.
Purpose: Outcomes following management of postoperative
spinal infections with VAC therapy, particularly those with
both exposed dura.
Study Design/Setting: Retrospective
review
of
prospectively collected data
Patient Sample: 40 patients treated between January 1,
2010 and October 1, 2015 by the lead author
Outcome Measures: Presence of healed wound
Methods: Routine demographic data was collected together
with comorbidities. Operative reports were reviewed and
duration and type of VAC treatment noted.
Results: All patients had 6 weeks of intravenous antibiotics.
31 patients had exposed dura of whom 28 had VAC sponge
applied directly to dura (interface of mepitel and white foam
and pressure of only 50mmHg) with a minimum of 1 week
VAC therapy and dressing changes every 2-3 days before final
closure. 3 patients required a muscle flap. 2 patients died
before definitive final closure due to other complications.
All the remaining patients went on to healed wounds.
The 3 other patients with exposed dura underwent
debridement, primary closure and application of an
incisional VAC dressing (50 mmHg pressure) and all went
onto healed wounds.
The remaining 9 patients in this cohort (with no dura
exposed) underwent debridement, VAC therapy (125mmHg
pressure) and delayed closure and all went onto healed
wounds.
Conclusions: VAC Therapy is effective in postoperative
spinal infections and safe when applied to exposed dura.
12.00-12.45
INSTRUCTIONAL SESSION
Management of symptomatic
spondylolysis
The development and natural history of PARS
lesions in professional cricket
Nick Peirce
(SP24) 11.55-12.00
Management of postoperative spine wound
infections using vacuum assisted closure (VAC)
therapy
Main Author: Robert Lee
93
The presentation will briefly share the experiences of English
cricket. Lumbar spine stress fractures (spondylolysis) are the
most costly injury in cricket with more than 3,000 days lost to
injury in 2015. The developing/immature spine is considered
the greatest period of risk, with the majority of injuries occurring
during the adolescence and as the players commence their
professional careers.
BRITSPINE 2016
Friday, 8th April
Fast bowling provides unique stresses to the human spine
and the unilateral loading of the spine provides interesting
asymmetry of both bone mineral density and content.
Uninstrumented fusion in failed conservative
treatment in low grade spondylolytic
spondylolisthesis with a normal disc
Graded and controlled exposure to load, whether it be
frequency, duration or intensity, remains the most important
factor in managing the prevention of spinal injuries. In those
that have sustained a spondylolysis, accelerated return to
bowling is the most common cause of failure in return to play
and recurrence of the injury. The surgical management of PARs
lesions has been relatively unusual in professional cricket,
although does occur in the academy populations. The role of
technique, additional strengthening and cross sport activities
in prevention also all appear to play a role in prevention.
Thanos Tsirikos
Conservative treatment in “young” patients with
symptomatic spondylolysis and a normal disc (on
MRI scan)
Robin Chakraverty
Spondylolysis injury is common in sport. Injury surveillance data
from British Athletics elite Olympic and Paralympic track and
field athletes with spondylolysis will be presented, including
an overview of the conservative management approach. Data
will be presented on subsequent sports performance which is
the most appropriate measure in elite sport ie, were they able
to better, or at least, equal their previous personal bests in
competition and within what timeframe?
Dr Chakraverty will then discuss a decision matrix for
spondylolysis injury in track and field which will give the delegates
an insight into what factors are brought into consideration when
management decisions are made in elite sport.
If conservative treatment fails the surgical treatment
consists of direct pars repair
Lester F Wilson
Percutaneous internal fixation can confidently heal an incomplete
fracture and will probably deal with most ‘acute’ separations.
Established fractures will require additional bone grafting.
In athletes, multifidus muscle, nerve and blood supply must be
respected. Direct screw [Buck] fixation is mechanically optimal.
Compression is desirable in terms of stability to reduce the
fracture gap and to compress the bone graft. A percutaneous
compression screw designed for trans-articular facet fixation
allows both sides to be fixed using a mid-line incision below the
spinous process. A Jamshedi needle docked onto the lamina
enables guide-wire insertion prior to drilling and tapping.
Autograft from the ilium remains the best graft material and this
can be harvested through a 1cm incision. We use a paravertebral
muscle splitting approach to the fracture and prepare the graft
bed using a high-speed burr. Graft containment is imperfect, but
surgicel is probably helpful. A CT scan at 4-6 months identifies
early issues with healing and occasional secondary grafting is
needed for more difficult fracture patterns. The failure rate is
around 10-15% and can usually be predicted on the basis of the
fracture morphology.
More complex fracture patterns include acute pedicle fractures
with established contralateral pars fractures and acute pars
fractures in the presence of a bifid spinous process. Internal
fixation of both sites is necessary, with grafting for the pseudarthrosis or bifid spine.
We reviewed 34 consecutive children and adolescents with
isthmic spondylolysis and grade I-II lumbosacral spondylolisthesis
who underwent in situ posterolateral arthodesis between the
L5 transverse processes and the sacral ala with the use of iliac
crest autograft. Ten patients had an associated scoliosis which
required surgical correction at a later stage in two patients with
idiopathic curves unrelated to the spondylolisthesis. No patient
underwent spinal decompression or instrumentation placement.
Mean surgical time was 1.5 hours and intra-operative blood loss
200 ml. There was one wound infection treated with antibiotics
but no other complication. Radiological assessment included
standing postero-anterior and lateral, Ferguson and lateral flexion/
extension views, as well as computed tomography scans. A solid
postero-lateral fusion was confirmed in all patients at mean latest
follow-up of 5.5 years beyond skeletal maturity into early adult life.
Fusion of the isthmic lesion was documented in 26.5% of patients
bilaterally and 23.5% unilaterally. The poor fusion rate across the
spondylolysis has not affected the excellent functional results
of the procedure which in our series depended on achieving a
stable lumbosacral junction. The solid lumbosacral fusion was
confirmed with radiographic and CT imaging and resulted in
complete resolution of low back and leg pain, as well as excellent
functional outcomes into early adult life. Quality of life assessment
demonstrated significant improvement in all functional scores and
high patient satisfaction with 28 patients returning to previous
sports activities at an elite competitive level.
When do I consider 360 degree fusion in a
spondylolytic spondylolisthesis?
Daniel Chan
There has been a major increase in the use of interbody fusion in
recent years. These include PLIF, TLIF, which include a posterior
fixation. Alternatives are ALIF, XLIF, OLIF, which can be done
stand alone, but often augmented posteriorly to achieve a 360
degree construct.
The purposes of carrying a more complicated interbody fusion,
be it from posteriorly or anteriorly rather than the more simple
in situ posterolateral fusion are:
1. Restoration of segmental alignment by restoring collapsed
disc height.
2. Restoration of foramenal dimension to achieve indirect
exiting nerve root decompression
3. To provide for additional fusion surface
4. To load share posterior instrumentation
In many cases of low grade spondylolytic spondylolisthesis,
however, simple in situ posterolateral fusion and Gill’s
laminectomy may suffice. The case for interbody fusion, and
in particular, 360 degree fusion in low grade spondylolytic
spondylolisthesis is made.
The post-operative rehabilitation is tailored to the sporting
demands of the athlete.
BRITSPINE 2016
94
Poster Presentations
Poster Presentations
Back Pain (Lumbar Degenerative)
(P02)
Single level versus multiple level lumbar disc
arthroplasty: a prospective study with 24 months
follow up
(P01)
Main Author: Nader Rehmatullah
Persistent CSF leak post spinal surgery and
cerebrospinal fluid dynamic disturbances: cause or
consequence?
Co Authors: Clare Morgan, Poornanand Goru, Ian
Shackleford
Affiliation: Warrington and Halton Hospitals NHS Trust,
Lovely Lane, Warrington, Cheshire WA5 1QG
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Low back pain is one of the most
prevalent spinal problems in the Western World and is only
set to increase as the population ages. Degenerative disc
disease is a significant contributor. Lumbar disc replacement
(LDR) aims to preserve motion and avoid fusion-related
complications
Purpose: We aim to determine whether LDR is an effective
operation and how single level (SL) compares to multi-level
(ML) replacement.
Study Design/Setting: We present our prospectively
collected outcome data for single and multiple level
arthroplasty using the Activ-L disc replacement.
Patient Sample: All patients who underwent lumbar disc
replacement at our hospital were included.
Outcome Measures: Clinical outcome measures include
the Oswestry Disability Index (ODI), Visual Analogue Scale
(VAS), Low Back Outcome Score (LBOS) and the Centre for
Epidemiologic Studies Depression Scale (CES-D).
Methods: All patients suffering from Degenerative Disc
Disease and who were suitable for LDR were assessed
preoperatively, at 6, 12 and 24 months by members of the
spinal team who collected the outcome data scores.
Results: Results for 177 patients comprising 97 SL and 80
MLs are reported. Significant improvement occurred in all 4
outcome measures in the first 6 months followed by a more
gradual improvement over the following 18 months. CES-D
outcome scores improved to a greater degree in the ML
cohort.
Conclusions: This is the largest study to date comparing
SL against ML lumbar disc arthroplasty. Our results suggest
both SL and ML lumbar disc replacements are an effective
operation for the treatment of DDD with continued benefit
over the course of 24 months.
Main Author: Akbar Khan
Co Authors: Claudia Craven, Ahmed Toma, Laurence Watkins
Affiliation: National Hospital for Neurology & Neurosurgery,
Queen Square, London WC1N 3BG
Conflicts of Interest: Nil
Funding Sources: Nil
Background Context: Cerebrospinal fluid (CSF) leak
following spinal surgery is a relatively common surgical
complication. A small group of CSF leak patients require
multiple surgical repairs and prolonged hospital admission.
Spinal CSF leaks are usually classically associated with
symptoms of low intracranial pressure (ICP). However, there
is a paucity of literature investigating the associated CSF
dynamics.
Purpose: Scientific investigation of persistent spinal CSF
leak post-surgery
Study Design/Setting: Retrospective cohort study.
Patient Sample: Patients with persistent CSF leak referred
to the hydrocephalus service in our unit for intracranial
pressure monitoring.
Outcome Measures: Physiological and clinical outcome
Methods: Retrospective case series study of patients with
persistent CSF leak referred to the hydrocephalus service in
our unit for intracranial pressure monitoring. Medical notes
were reviewed for clinical presentation, management and
outcome. Images were reviewed and ICP data were analysed.
All patients underwent Continuous ICP monitoring using
Spiegelberg ICP bolts.
Results: Three Patients had spinal fixation surgery,
complicated by prolonged CSF leaks (mean of 56 days).
Each patient required 2 re-explorations spinal surgeries
and multiple lumbar drains insertions prior to 24 hours
ICP monitoring. All patients were shown to have raised ICP
(>15.2mmHg). One patient underwent a right transverse
venous sinus stent insertion. Two patients underwent
insertion of ventriculo-peritoneal shunts (VPS). All three had
resolution of their CSF leaks immediately post intervention.
Conclusions: Our results suggest that abnormal
cerebrospinal fluid dynamics should be explored in patients
with persistent CSF leak post spinal surgery. Whether
abnormal pressure and dynamics represent a pre-existing
abnormality or is induced by spinal surgery should be
subject for further studies.
95
(P03)
Lumbar spine curvature varies with modic changes
and disc degeneration in asymptomatic individuals
Main Author: Anastasia Pavlova
Co Authors: Janet Deane (Imperial College London,
Musculoskeletal Lab, Charing Cross Campus, London
W68RP), Richard Aspden (University of Aberdeen, Institute
of Medical Sciences, Foresterhill, Aberdeen AB25 2ZD),
Alison McGregor (Imperial College London, Musculoskeletal
Lab, Charing Cross Campus, London W6 8RP
Affiliation: University of Aberdeen, Institute of Medical
Sciences, Foresterhill, Aberdeen AB25 2ZD
BRITSPINE 2016
Poster Presentations
Conflicts of Interest: No conflicts of interest
Funding Sources: Arthritis Research UK £232,344 Nurse and
Allied Health Professional Training Fellowship #20172 (JD)
and Society for Back Pain Research £1000 Travel Fellowship
(Anastasis Pavlova)
Background Context: Degenerative Lumbar Disc Disease
(DLDD) is significantly associated with signs of lumbar disc
(LDD) and vertebral degeneration (Modic change or MC)
and symptoms of recurrent low back pain. An association
between spinal curvature and DLDD in asymptomatic
individuals has not been previously considered.
Purpose: To compare lumbar spine morphology between
asymptomatic individuals.
Study Design/Setting: Cross-sectional 3T MRI study.
Patient Sample: Thirteen asymptomatic adults aged 45-70.
Outcome Measures: Lumbar MC, modified Pfirrmann
grades (LDD) and mode scores characterising lumbar spine
shape from statistical shape modelling (SSM).
Methods: T2-weighted sagittal lumbar spine images were
acquired and graded for MC and LDD at each vertebral level
by an experienced radiologist. An SSM was built describing
the spine from T12-S1 and identified patterns (modes) in
lumbar morphology variation. Individuals’ mode scores were
compared between those with (n=8 and 10) and without
(n=5 and 3) MC or LDD (modified Pfirrmann ≥6) at one or
more levels, respectively.
Results: Mode 1, describing total curvature, accounted for
66% variation. People with MC were more lordotic (larger
M1 score) (P=0.02, t-test) whereas individuals with LDD
had no significant differences in M1 but scored lower in M7
(P=0.02), describing reduced disc space specifically at L5/S1.
Seven people (54%) had both MC and LDD and scored lower
in M7 (P=0.02).
Conclusions: Asymptomatic MC individuals were more
lordotic than those without. This is in contrast to previous
studies of symptomatic patients who have a flattened
lordosis. These early results suggest spinal shape is
associated with standard markers of DLDD and could play a
biomechanical role in future pain development.
(P04)
A cross-sectional survey of the understanding of
cauda equina syndrome
Main Author: Rowa Taha
Co Authors: Andrea Thompson, Shuaib Karmani, Sherief
Elsayed
Affiliation: South East Spinal Surgery, Brighton University
Hospitals NHS Trust, Brighton
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Caudal equine syndrome, CES, is a
rare disorder with a disproportionately high litigation rate.
Recognition of CES by all groups of clinicians is often delayed.
The most junior member of the team routinely performs
initial assessment; we rely on their clinical judgement in
identifying these patients correctly and promptly instigating
appropriate investigation and management.
Purpose: 1. To assess junior doctor understanding of CES.
2. To assess variability in knowledge amongst clinicians from
BRITSPINE 2016
different specialities.
Study Design/Setting: Prospective survey of junior doctors
in various specialities.
Patient Sample: Not applicable
Outcome Measures: Knowledge and competence in
recognising and managing CES.
Methods: Questionnaires distributed at departmental
and deanery teaching. Data anonymously collected and
analysed using SPSS(v20).
Results: N= 39; FY1 to SpR. 74% of assessing clinicians were
foundation doctors, with only undergraduate teaching in
CES. Only 5% had received specific CES teaching within the
prior 6 months. 10(26%) would perform rectal examination.
13(33%) perform a bladder scan pre-and-post voiding.
87% reported knowledge of CES was not satisfactory and
all doctors (100%) stated they needed additional teaching.
12(31%) recognised post-void residual of >100ml as
abnormal. There was wide variation in what was perceived
to be the most clinically significant finding.
Conclusions: Many doctors assessing CES have not
received any formal postgraduate teaching on CES. There
is poor understanding of the clinical significance of certain
symptoms and use of bedside investigations. A universal
teaching course is required for all doctors assessing CES.
Improved education may lead to prompt recognition,
timely investigation and treatment, thus reducing the
risk of residual neurological compromise and consequent
litigation.
(P05)
Mid-term results for coflex inter-spinous dynamic
stabilization device in degenerative lumbar
stenosis. The good, the bad and the ugly.
Main Author: Tamer Kamal
Co Authors: Sherif El Nikety2, James Casha2, Nitin Shah2
Affiliation: 1.Royal Hampshire County Hospital, Winchester
2.East Kent Hospital, Margate
Conflicts of Interest: “No conflicts of interest”
Funding Sources: “No external funding obtained”
Background Context: The concept of dynamic stabilization”
or “soft stabilization” was introduced with aim to provide a
solution to problems related with spinal fusion. In theory,
dynamic stabilization system should provide sufficient
support at the inserted level allowing for load transmission
of a spinal motion segment, without major restriction to
motion at the affected segment allowing to relieve pain and
avoiding adjacent level disease encountered with spinal
fusion.
Purpose: Assessment of outcomes of Coflex dynamic
stabilisers
Study Design/Setting: Prospective study between February
2008 and December 2011 at the Queen Elizabeth The Queen
Mother Hospital, East Kent NHS Trust, Margate, Kent.
Patient Sample: Mild to moderate degree lumbar
degenerative foraminal stenosis
Outcome Measures: Self-report measures: validated pain
rating scale, Oswestry disability questionnaire
Methods: 121 patients with mild to moderate degree
degenerative lumbar spinal foraminal stenosis (LSS) patients
96
Poster Presentations
were included in a prospective study at the Queen Elizabeth
The Queen Mother Hospital, East Kent NHS Trust, Margate, Kent.
Results: The Majority of patients were satisfied with the
results in the immediate postoperative period with 82% of
patients happy with surgical outcome. Visual analogue score
results improved in both groups with a mean preoperative
VAS score 8.4, 4 at one year 3.2 for the decompression and
coflex group (p<0.05), and a mean preoperative score VAS
score of 7.8, 4.5 at one year and 5.1 at two years (P=0.4)
The mean Pre-operative ODS score was 76.8%, 36.25% at
one year and 42.8 % at 2 years.
Around the 2- 3 years period there was a higher rate of
recurrence of symptoms with pain not responding to nonoperative management with 36% rate of revision surgery.
Conclusions: The Coflex@ inter-spinous implant is a
simple surgical treatment strategy with a low risk. Early
results show a good improvement of both clinical and
radiological parameters combined with patient satisfaction
specially if combined with spinal decompression. Despite
early satisfactory results, it seems that the device efficacy
gradually decreases with patients complaining of recurrence
of symptoms at 18-36 month period, between 24-48 month
post-operative follow-up demonstrated a high rate of
recurrence and even worsening of symptoms with 36% rate
of reversion surgery.
(P06)
Sacroiliac minimal invasive fusion compared to
physical therapy: six-month outcome from a multicenter randomized controlled trial
Main Author: Bengt Sturesson
Co Authors: Julius Dengler, Djaja Kools, Robert Pflugmacher,
Domenico Prestamburgo
Affiliation: Aleris Ortopedi, Sjukhuset, Södra vägen, 26252
Ängelholm
Conflicts of Interest: Bengt Sturesson is a paid Lecturer for
SI-BONE
Funding Sources: The study is supported by grants from SiBONE
Background Context: Sacroiliac (SI) joint dysfunction is
a common cause of chronic, unremitting lower back or
buttocks pain.
Purpose: To compare outcomes after surgical and nonsurgical conservative treatment for SI joint dysfunction.
Study Design/Setting: Multi Center Prospective
Randomized Controlled Trial
Patient Sample: 103 patients
Outcome Measures: VAS, ODI, EuroQOL-5D, Zung
depression questionnaire, Provocative physical examination
tests, Active Straight Leg test (ASLR)
Methods: 103 subjects with SI joint dysfunction were
randomly assigned to minimally invasive SI joint fusion with
triangular titanium implants (iFuse, SI-BONE) (SIJF, N=52)
or conservative management (CM, N=51). CM consisted
of physical therapy according to European guidelines
and cognitive behavioural treatment. The following were
assessed at baseline and follow-up: self-rated SIJ pain (0100 scale), Oswestry Disability Index, EuroQOL-5D, Zung
depression questionnaire, provocative physical examination
tests, and active straight leg raise test (ASLR). The study is
97
supported by grants from SI-BONE.
Results: At 6 months, the improvements in SIJ pain and
Oswestry Disability Index were higher in the SIJF group
vs. CM group (both p<.0001). At 6 months, the number of
positive provocative physical examination tests improved
and mean ASLR ratings decreased (p<.0001 each); in the
CM group there was no improvement (p >.3 for both
comparisons). Quality of life improved more in the surgical
group compared to the CM group.
Conclusions: Six-month results from this level 1 study
showed that minimally invasive SI joint fusion using
triangular titanium implants was more effective than nonsurgical management in relieving pain and disability,
improving function, and improving quality of life in patients
with SI joint dysfunction.
(P07)
Radiological evaluation of the rate of interbody
fusion using posterior/transforaminal interbody
fusion with a missed screw technique
Main Author: S Khan
Co Authors: M Mansha, M Hernandez, A Batra, C Bhatia, M
Krishna
Affiliation: University Hospital of North Tees, Hardwick
Road, Stockton-on-Tees, Cleveland TS19 8PE
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Posterior or transforaminal Interbody
fusion has been performed for about 7 decades to treat
degenerative lumbar spine disease. The aim of our study
was to evaluate the rate of Interbody fusion using Posterior
or Lumbar interbody fusion with a missed screw technique.
In our study, Interbody fusion was performed at two levels
with no intervening screw at the middle vertebral pedicle.
Purpose: To look at the lumbar interbody fusion rate using
missed screw technique
Study Design/Setting: Prospective Radiological Analysis
Patient Sample: 40 patients
Outcome Measures: Imaging ( X rays)
Methods: The study involved a prospective radiological
analysis of retrospectively performed Posterior/
Transforaminal Interbody fusion performed at two levels
with a missed screw technique in forty patients. The
radiographs were assessed independently by a Consultant
Radiologist and a Spinal Surgeon both commenting on
fusion rate using Brantigan-Steffee fusion criteria. The criteria
include a denser and more mature bone fusion area than
originally achieved at the time of operation, no interspace
between the cage and the vertebral body, and mature bony
trabeculae bridging the fusion area. The procedures were
performed by one Spinal surgeon.
Results: In our study of 40 patients, we had 24 males and 16
females with an average age of 44.7 years in both groups.
The main indication of performing Interbody fusion was
degenerative lumbar spine disease. Fusion procedures
were performed over a period of 3 years and 6 months
with an average follow up of 19.8 months. Radiographs as
independently reviewed by Radiologist and Spinal surgeon
revealed that 29 patients (76.31%) were fused at both levels,
BRITSPINE 2016
Poster Presentations
one level was fused in 3 patients (L4/5 in 2 patients and L5/
S1 in 1 patient), two patients did not have adequate follow
to comment on fusion and non-fusion was found in six
patients.
Conclusions: Our study concluded that it may not be
necessary to insert a screw at the middle vertebral pedicle
while performing PLIF/TLIF at two levels.
(P08)
Magnetic resonance imaging predictors of recurrent
disc prolapse in lumbar spine
Main Author: Hassan Fawi
Co Authors: Jose Magol, Mohamed Ahmed, Tanya Chopra,
Munier Hussien, Abdel Gaffar Dudhniwala, Sashin Ahuja
Affiliation: Welsh Centre For Spinal Trauma and Surgery
Conflicts of Interest: Non
Funding Sources: Non
Background Context: Although recurrent disc prolapse
after lumbar discectomy is a well-established postoperative
concern, nevertheless little is known about its possible
predicting factors.
Purpose: To describe magnetic resonance imaging
characteristics in a large sample of patients who underwent
primary discectomy for single-level disc prolapse in
comparison to those with recurrent lumbar disc prolapse, and
to investigate associations between these characteristics.
Study Design/Setting: Cross-sectional study. Tertiary Spinal
Centre.
Patient Sample: 731 consecutive patients who underwent
discectomy for single level disc prolapse over a 6 years
period, with a minimum follow-up of 2 years.
Outcome Measures: Recurrence, Retrolisthesis and Modic
Changes.
Methods: Eligible patients had a pain free period of at least
6 months after their primary operation. MRI scans of the
lumbar spine were assessed at spinal level L1–S1 for all 731
patients.
Retrolisthesis was defined as posterior subluxation of 8%
or more. Modic changes were graded 1 – 3 and collectively
classified as vertebral endplate degenerative changes.
Results: 731 adult patients. Age range (18-87years).
Distribution of preoperative disc prolapse L2/3: 27 patients
(3.69%), L3/4: 75 patients (10.25%), L4/5: 306 patients
(41.86%), and L5/S1: 323 patients (44.18%).
59 patients had recurrence (8% prevalence). Levels of
recurrence were L3/4: 7pts, L4/5: 27pts, and L5/S1: 25pts.
The presence of retrolisthesis and Modic changes in
degenerate discs preoperatively were all found to be
positive predictors of recurrence in univariate analysis. The
risk of recurrent prolapse in patients with retrolisthesis and
modic changes were significantly higher as per multivariate
analysis.
Conclusions: The preoperative MRI seems to provide
important predictors of recurrence in patients undergoing
primary lumbar discectomy. Hence patients with these risk
factors should be counselled preoperatively.
BRITSPINE 2016
(P09)
The utilisation of post micturition bladder scan in
the assessment of patients with suspected cauda
equina syndrome (CES)
Main Author: Michelle Angus
Co Authors: Mohammed Elmajee, Rajat Verma, Saeed
Mohammad, Irfan Siddique
Affiliation: Salford Royal NHS Foundation Trust (SRFT), Stott
Lane, Salford M6 8HD
Conflicts of Interest: Nil
Funding Sources: Nil
Background Context: CES presents with many differing
symptoms and signs. Many of the objective clinical signs
can be vague and inconsistent.
Purpose: To establish the clinical reliability of a post
micturition bladder scan in independently predicting
compression of the cauda equina.
Study Design/Setting: Consecutive patients presenting
at the Emergency Department (ED) of a tertiary care spinal
centre investigated for signs of CES.
Patient Sample: 40 patients
Outcome Measures: An MR scan was used as a gold
standard for the identification of compression of the cauda
equina.
Methods: All patients had a post micturition bladder scan
as part of their clinical assessment in the ED, they then went
on to have an MR scan to establish if the cauda equina was
compressed. The bladder scan results were then compared
with those with a positive MR scan for CES and subsequent
diagnosis of incomplete CES (CESI) or CES with retention (CESR).
Results: 25% of the sample were classed as positive for CES
and went on to have surgical decompression, of these 18%
were catheterised, a further 54% had a residual volume of
>100ml after urinating, with the remaining 28% able to
empty their bladder. The larger volume of patients had no
CES on MR, 3% of this group required catheterisation and
31% had a residual volume of >100ml with 66% able to fully
empty their bladder.
Conclusions: A post micturition bladder scan is a useful
adjunct to the clinical assessment of patients with suspected
CES however it should be used with caution as an independent
predictor as, by itself, it appears to have a low sensitivity for
CESI and low specificity for both CESI and CESR.
(P10)
Patient reported outcome measures: the accuracy of
patient reported revision spinal surgery
Main Author: Elmajee Mohammed
Co Authors: Aljawadi Ahmed, Ben-nafa Walid, Rajat Verma,
Saeed Mohammad, Siddique Irfan
Affiliation: Salford Royal NHS Foundation Trust (SRFT),
Manchester
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Patient reported outcome measures
form a major part of registry data collection and, beyond
98
Poster Presentations
functional outcome scores, may be utilised to establish
whether patients have undergone revision spinal surgery
and additionally whether this was performed at the same or
a different spinal level.
Purpose: We aimed to establish the accuracy of patient
reported revision surgery
Study Design/Setting: Analysis of prospectively collected
data
Patient Sample: 4,247 patient reported outcome measures
collected at 3 months postoperatively
Outcome Measures: Validation against patient’s electronic
patient records
Methods: 4,247 patients who completed PROMS at 3
months postoperatively between August 2011 and August
2015 were included in the study. The surgical history of
these patients was accessed to compare it with the answers
obtained from the patients’ questionnaire. Any intervention
including revision surgery, management of complications,
and spinal injection from the time of the last lumbar surgery
to date of the questionnaire were noted and compared with
the responses given by patients.
Results: A number of 4,143 patients reported no further
surgeries. 4,116 out of 4,143 patients were truly negative,
and 27 were false negative as they had further surgical
interventions.
104 patients reported revision surgery. 72 patients out of
104 were truly positive and described the correct segment,
whereas, the remaining 32 patients were falsely positive.
This is because they had no surgeries, spinal injections,
or surgery at a different level. This the sensitivity of this
question was found to be 72.7%, and specificity 99.2%.
Conclusions: This study demonstrates the utility of this
question to assess the revision surgery rates in spinal
surgery. However, with the lower than expected sensitivity,
revision rates may be reported by patients as higher than
they actually are.
(P11)
Pedicle distraction increases vertebral foramen area
- a pilot study
Main Author: Matthew Hughes
Co Authors: Nik Papadakos, Jason Bernard
Affiliation: St George’s University of London, Tooting,
London SW17 0RE
Conflicts of Interest: None to declare
Funding Sources: No funding obtained
Background Context: Lumbar spine stenosis, a
degenerative condition, involves narrowing of the spinal
canal or intervertebral foramen. Surgical management
involves laminectomy to decompress the entrapped
nerves, however this technique causes significant trauma
and vertebral instability. The proposed minimally invasive
technique involves increasing pedicle length to decompress
affected nerves.
Purpose: To identify the effect of pedicle distraction on the
dimensions of the intervertebral foramen and spinal canal.
Study Design/Setting: Scientific experiment
Patient Sample:
Outcome Measures:
99
Methods: 3 Sawbone lumbar spines underwent bilateral
pedicle distraction at L4. A channel was drilled through the
pedicles into the vertebral body. The pedicles underwent
osteotomy at the midpoint perpendicular to the channel.
Screws were inserted to fixate the distraction at 0 mm, 2 mm,
4 mm and 6 mm. The spines underwent CT scanning at each
stage. Intervertebral foramen area was measured at L3/4.
Spinal canal area was measured at L4. Statistical analysis was
by student paired t-test and Pearson rank test.
Results: Each increase in distraction showed greater Spinal
canal area. Maximal area increase of 34.1% was seen with
6 mm distraction. Area increased from 4.27 cm^2 to 5.72
cm^2 (p= 0.002.)
Vertebral foramen area increased with greater distraction. A
maximal increase of 32.3% was seen with 6 mm distraction.
Area increased from 2.43 cm^2 to 3.22 cm^2 (p= 0.022.)
Conclusions: With greater pedicle distraction the area
of the spinal canal and vertebral foramen increases.
Pedicle distraction could alleviate spinal stenosis and root
impingement. Further study into the soft tissue interactions
is needed to quantify its potential as a treatment.
(P12)
Outcome of a prospective multi-center
observational data-monitored study of minimally
invasive fusion in the surgical treatment of
degenerative lumbar disorders: one year follow up
study
Main Author: Khai Lam
Co Authors: Neil Manson
Affiliation: Guys and St Thomas NHS Hospitals, Great Maze
Pond London SE1 9RT
Conflicts of Interest: Neil Manson Consultant for Medtronic
Canada
Funding Sources: Medtronic
Background Context: To Present the Outcome of a
Prospective Multi-center Observational Data-monitored
Study Of Minimally Invasive Fusion (MILIF) in the Surgical
Treatment of Degenerative Lumbar Disorders: One year
follow up Study
Purpose: Present 12 months outcome of a study on
Minimally Invasive Fusion (MILIF) for Degenerative Lumbar
Disorders (DLD) (NCT01143324).
Study Design/Setting: Multicenter prospective observational
Patient Sample: 252
Outcome Measures: Patient demographics, intra-operative
data, complications, time to first ambulation and to study
defined recovery, surgical duration, blood loss, fluoroscopy
time, adverse events (AEs), patient outcomes (VAS back and
leg, ODI, EQ-5D) were assessed pre-op and 4w/12m post-op.
X-rays was used to assess fusion.
Methods: 19 centers in 14 countries treated 252 patients
with 1-level (1L) (83%) or 2-level (2L) (17%) MILIF (TLIF: 95%;
PLIF: 5%) for leg pain (52%), back pain (39%) or claudication
(9%) due to DLD [spondylolisthesis (53%), stenosis (71%),
and/or disc pathology (94%)].
Results: 99% (249/252) of patients were available at 4w
and 93% (233/252) at 12m. 91% of 1L surgeries occurred at
L4-5 or L5-S1 and 74% of 2L surgeries were at L4-S1. Fusion
BRITSPINE 2016
Poster Presentations
rates were: 90.8% for 1L and 90.7% for 2L. Mean 1L/2L
surgical duration, blood loss, fluoro-time were 128/182
mins, 164/233 ml, and 115/154 secs. Mean time to first
ambulation and study defined recovery were 1.3 and 3.2
days. Patient outcomes at pre-op; 4w; 12m: VAS back 6.2; 2.9;
2.9, VAS leg 5.9; 2.5; 2.2, ODI% 45.5; 34.5; 22.4, EQ-VAS 52.9;
65.4; 71.0, EQ-5D index 0.34; 0.61; 0.71 (all values p<.0001).
EQ-5D subscales and pain medication reduced to 12m. 39
patients (15.5%) had 50 AEs (9 serious) attributed to surgery,
approach, or device. Three AEs were attributed to MILIF (1
serious). 7 additional surgeries occurred (4 adjacent, 3 at
target level).
Conclusions: Our study shows early favorable clinical
patient outcomes in MILIF, with sustained improvement and
low major perioperative morbidity.
(P13)
Outcomes of endoscopic uniportal transforaminal
discectomy for the treatment of lumbar disc
herniation
Main Author: Giuseppe Lambros Morassi
Co Authors: Galateia Katzouraki, Spyros Koufos, Dimitrios
Stergios Evangelopoulos, Vasileios Polyzois, Spyros
Pneumaticos
Affiliation: The Center for Spinal Studies and Surgery,
Nottingham; 3rd Department of Orthopaedic Surgery, KAT
Hospital, University of Athens, Athens, Greece
Conflicts of Interest: Nil
Funding Sources: Nil
Background Context: Microdiscectomy is the golden
standard treatment for lumbar disc herniation in cases
where conservative treatment has failed. Success rate of up
to 85% are reported.
Purpose: The objective of this study was to examine
the safety and efficacy of fully endoscopic uniportal
transforaminal lumbar discectomy
Study Design/Setting: Retrospective study
Patient Sample: Sixty five patients underwent percutaneous
uniportal full endoscopic transforaminal during a period of
four years.
Outcome Measures: Neurological examination findings,
VAS score and Oswestry Low Back Pain Questionnaire were
used as follow-up measurement instruments before surgery,
immediately post-surgery, at 6 weeks, 6 months, 12 months
and 24 months post-surgery.
Methods: Sixty-five patients underwent percutaneous
uniportal fully endoscopic transforaminal discectomy during
a period of four years. The procedures were performed under
general anaesthesia with the patients in prone position
Results: After endoscopic surgery the VAS score for leg pain
and back pain improved after 6 weeks from surgery in 90%
of the patients. The Oswestry Disability Index improved from
a mean of 76% to 26% at 6 weeks after surgery. These results
persisted in the majority of patients during follow-up to 24
months. There was no worsening of neurological findings in
any the patients. The recurrence rate was 9.2% (6 patients).
Open microdiscectomy was performed on the patients
which failed endoscopic transforaminal discectomy. No
major complications were reported.
Conclusions: The results of the full endoscopic transforaminal
BRITSPINE 2016
discectomy are comparable with those of microdiscectomy.
The advantages of the endoscopic discectomy are the limited
surgical approach, minimal injury of the paraspinal muscles
and epidural vessels and the prevention of instability.
However, the major advantages of the technique are the
limited hospitalization time (less than 24h) and the early
return to work (mean time 28 days).
(P14)
Comparison of intrathecal diamorphine with
conventional methods of analgesia following
transforaminal lumbar interbody fusion (TLIF)
surgery
Main Author: Ramprabu Krishnan
Co Authors: Robert Lee, James Kennedy, Fady Sedra
Affiliation: Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore, Middlesex HA7 4LP
Conflicts of Interest: No conflicts of interest
Funding Sources: None
Background Context: Unrelieved postoperative pain
following lumbar surgery can lead to severe complications.
Intrathecal opioids (morphine) following spinal surgery have
been described but can be associated with an increased
incidence of late respiratory depression.
Purpose: To compare outcomes between two cohorts of
patients undergoing TLIF (1-2 level) surgery having either
spinal diamorphine or conventional analgesia.
Study Design/Setting: Retrospective comparative study
Patient Sample: 60 consecutive patients undergoing
minimally invasive TLIFs performed by single surgeon
and anaesthetist. Spinal diamorphine was injected by the
anaesthetist with the patient under GA before the surgical
incision
Outcome Measures: Perioperative analgesic requirement,
immediate recovery and postoperative pain scores,
estimated blood loss (EBL), side effects, critical care and
length of stay and indicators of gastrointestinal function.
Methods: Retrospective notes review and statistical analysis
with a standard t-test.
Results: 32 patients had spinal diamorphine and 28 no
diamorphine. Patient demographics are comparable. Mean
dose of diamorphine injected intrathecally was 1.56mg
(range 1-2mg, 20-30mcg/kg). Patients in the diamorphine
group had less blood loss (330 vs. 556 mls), had less PCA
opioid consumption, less pain scores at recovery and for up
to 48 hrs postoperatively and opened their bowels earlier
(3.7 vs 4.4 days). All were statistically significant (p<0.05).
The length of stay in critical care (average 1 day both
groups) and hospital were similar (5.4 days vs 6 days). There
was no respiratory depression requiring naloxone in the
diamorphine group.
Conclusions: Spinal diamorphine provides better analgesia
than conventional analgesia methods following lumbar
spinal surgery. Spinal diamorphine is safe and might
decrease intraoperative blood loss.
100
Poster Presentations
(P15)
Lumbar spine angles in subject’s with a history of
flexion-related back pain when performing a typing
task
Main Author: Aideen Larmer
Co Authors: Liba Sheeran, Valerie Sparkes
Affiliation: Cardiff University, School of Healthcare Sciences,
Heath Park, Cardiff CF14 4XN
Conflicts of Interest: None
Funding Sources: None
Background Context: Lower back pain is a highly prevalent
musculoskeletal condition with high economic costs to
governments and individuals. A classification approach that
sub-groups individuals based on the movement activities
that aggravate their back pain will specifically target
treatment. Prolonged sitting is a common aggravating
activity for many back pain sufferers. Further understanding
of the sitting behaviours of the sub-group of individuals with
flexion-aggravated back pain could help guide intervention.
Purpose: To determine Lumbar spine angles when
performing a typing task
Study Design/Setting: Observational Design, School of
Healthcare Sciences Research Laboratory
Patient Sample: Volunteers from Cardiff University
Physiotherapy students, with a history of flexion-related
low back pain
Outcome Measures: Lumbar Spinal angles
Methods: 17 volunteers with a history of flexion-related
back pain were recruited. Institutional ethical approval
was gained and all subjects provided informed consent.
Reflective markers were placed on specified lumbar and
pelvic landmarks.
The lumbar spinal angles were measured at baseline (0
minutes) and after 15 minutes of a typing task. Spinal
angles were calculated using MATLAB. Wilcoxon signed rank
non-parametric test compared differences in spinal angle
between the time points.
Results: A significant difference (p=0.02,) was found
between lumbar angles at 0 and 15 minutes. The majority of
participants demonstrated a reduced flatter lumbar lordosis
after 15 minutes
Conclusions: There is a significant change in lumbar spinal
angle with a tendency to move into a flatter lordosis after
sitting for fifteen minutes, however it is important to note
that a variety of postures are adopted even when individuals
are sub-classified. Specific assessments are required to
inform rehabilitation.
(P16)
Fusion rates following distraction interference
arthrodesis of the sacroiliac joint. A retrospective
study of post-op CT scans
Main Author: Katrina Treon
Co Authors: Adeline T Clement, Niall J A Craig
Affiliation: Woodend General Hospital, Aberdeen AB15 6XS
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
101
Background Context: Sacroiliac joint pain, often overlooked
yet significantly debilitating, may present as a primary
source of pain or secondary to previous lumbar spine fusion
similar to adjacent segment wear.
Minimally invasive techniques with their perceived
advantages of less operating time, blood loss, morbidity
and inpatient stay are now described and utilised. However,
little radiologic evidence exists to support the use of such
techniques for sacroiliac joint fusion.:
Our centre performs distraction arthrodesis for recalcitrant
pain. Patients are routinely followed up with both x-ray and
Computerized Tomography to assess fusion.
Purpose: This study aims to ascertain radiologic fusion rates
by CT scan.
Study Design/Setting: Retrospective case analysis
Patient Sample: All patients with postoperative CT imaging
Outcome Measures: Fusion on CT scan
Methods: All patients who had undergone distraction
interference arthrodesis neurovascular anticipating (DIANA)
as a primary procedure were identified. CT scans were
analysed to assess for fusion. Operation notes were used to
ascertain the type of bone graft utilized. Case notes were
reviewed to identify smoking status and previous surgical
procedures.
Results: 37 patients were identified with CT imaging.
Average age was 51 years old. Average time to CT scan was
13 months postoperatively. Overall fusion rate observed was
51.4%.
Conclusions: Overall fusion rate in this series is lower
than previously described. This appears to be graft
dependent. Radiologic fusion does not appear to correlate
with symptoms as only 3 patients went on to revision
procedures. Further studies are ongoing to assess fusion
rates and the optimum time for CT in these patients.
Cervical Spine
(P17)
Reliable measure of safe zone for cervical spinal
surgery in keeping of the embryologic origins of the
course of the recurrent laryngeal nerve (RLN) nerve
on right and left
Main Author: Ali Rajabian
Co Authors: Michael Walsh, Nasir A Quraishi
Affiliation: The Centre for Spinal Studies and Surgery,
Queen’s Medical Centre, Nottingham NG7 2UH
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Considerable variations are
observed of a “safe zone” for avoiding RLN injury during
anterior cervical exposures. Most studies have attempted to
accurately measure RLN versus the background of cervical
vertebrae level. However all studies so far have not factoredin the unique embryology of RLN following the descent
of the aortic arches. Thus, making it a floating structure
separate from the bony spine.
Purpose: We aimed to measure the positional variation of
this floating complex (RLN, Larynx, Oesophagus) in fresh
cadavers that are not yet fixed.
BRITSPINE 2016
Poster Presentations
Study Design/Setting: Fresh Cadaveric study
Patient Sample: Eight fresh cadavers
Outcome Measures: Anatomical measurement and High
quality photographs of Cadaveric study
Methods: 8 fresh cadavers were dissected to measure the
point at which RLN on the right and left sides joined the
Tracheoesophageal groove TEG medially (considered safely
protected) thence ascending to enter larynx. This was also
measured against backdrop of the cervical level with neck in
neutral and extension.
Results: The RLN joins the TEG 4.45 cm vertically inferior to
laryngeal prominence on the right and 7.7 cm on the left
(Range of +/- 0.5 cm). There were significant variations of
this point (RLN joining TEG) measured with neck in neutral
and extension by approximately 1.8 cm (+/- 0.3 cm) (the
length of one vertebral level (Photographed).
Conclusions: Whilst the use of vertebral level landmarks
may work well for nerve structures exiting or attached to
the ‘fixed’ spine, landmarking of a totally free floating nerve,
such as the RLN is not practical. This nerve is closely related
embryologically to that of the pharyngeal pouches and aortic
arches and can undergo positional variation as described.
Neck positioning during anterior cervical procedures can
produce variations in the location of the recurrent laryngeal
nerve. This is due to this structure as a ‘free floating nerve’
and its different embryological origins (to the spine). The
RLN joins the TEG approximately 4.5cm and 8 cm below the
laryngeal prominence on the right and left sides respectively.
(P18)
In vivo remodelling an organic bone mineral spinal
fusion
Main Author: Alan Parish
Co Authors: Scott Johnson, Gregory Kesteloot, Donal
McNally
Affiliation: University of Nottingham, University Park,
Nottingham NG7 2RD
Conflicts of Interest: Research funded by Cerapedics
Funding Sources: Research funded by Cerapedics
Background Context: Issues such as donor site morbidity
make bone graft substitutes an attractive option for
cervical fusions. Such material will eventually re-model into
trabecular bone as fusion progresses.
Purpose: In order to assess the progression of fusion, it is
important to be able to quantify such remodelling; ideally
both in terms of structure and mechanical function.
Study Design/Setting: This is a cohort study of the time
course of anterior cervical interbody fusion.
Patient Sample: Patients who have received spinal fusions
Outcome Measures: Porosity and volume measurement
Methods: Implanted anorganic bone mineral (ABM) was
scanned at post op, 3 months and 6 months with a 3D CT scan,
the region of the ABM was first segmented by hand, then a
multistage segmentation algorithm was applied to segment
out the bone in the region of interest while compensating
for both beam hardening and x-ray scattering. This was all
performed in the software mimics (materialise).
Results: It was shown that there was clear sign of remodelling
of the ABM and replacement with bone forming a trabecular
BRITSPINE 2016
network with the internal porosity increasing from 3 to 6
months with a mean porosity of 17±12% at 3 months and
24±11% at 6 months.
Conclusions: The implanted ABM has shown clear
remodelling, after both 3 and 6 months in vivo as shown
by the increase in porosity of the implant opposed to just a
reduction in volume from the outer surfaces in.
(P19)
Long term results of multi-level (three and four
levels) cervical disc arthroplasty: age-weighted linear
regression analysis - results from a single centre
Main Author: M Rajesh
Co Authors: S Khan, S Friesem, C Bhatia, G Reddy
Affiliation: University Hospital of North Tees, Hardwick,
Stockton on Tees, TS19 8PE
Conflicts of Interest: No conflicts of Interest
Funding Sources: No funding obtained
Background Context: The clinical outcomes of Multi-level
disc arthroplasties are variable in the literature. However,
the outcome results related to age would have a significant
bearing on our decisions in considering patients for surgery.
We reviewed 51 patients who had 3 & 4-level cervical disc
arthroplasties at our center.
Purpose: To look at the clinical outcome of age on Mutilevel
Cervical Arthroplasty
Study Design/Setting: Retrospective
review
of
Prospectively collected data
Patient Sample: 51 patients
Outcome Measures: NDI (Neck Disability Index), Depression,
Anxiety, Bodily Pain, Visual Analogue score for Neck (VAS
Neck), and Visual Analogue score for Arm (VAS Arm)
Methods: The study involved a retrospective review of
prospectively collected data on Multi-level (three and four
levels) cervical arthroplasty patients with an average age
of 54.64 (median age: 52, range: 34-80). Fifty one patients
were followed up for 2 to 5 years based on clinical outcomes
scores which were reviewed using data including NDI (Neck
Disability Index), Depression, Anxiety, Bodily Pain, Visual
Analogue score for Neck (VAS Neck), and Visual Analogue
score for Arm (VAS Arm). Scores were collected preoperatively and at each follow up at 3 months, 6 months,
1st and yearly afterwards. Linear Regression Analysis was
performed to look at the impact of age on these scores.
Results: The study consisted of 24 females and 27 males. The
average duration of symptoms was about 62 months (range:.
0-300months) for Multilevel Cervical Arthroplasty patients. The
indication for surgery was radiculopathy and a combination
of radiculopathy and myelopathy. Linear Regression Analysis
for NDI and age showed a Pearson Co-relation (r = 0.243); P
Value: 0.051, for VAS Neck (r = 0.251); P Value: 0.044, VAS Arm (r
= 0.392); P Value: 0.001. The slope on the scatter plots for these
3 outcome scores showed there was a better outcome with
age. There was significant improvement in the score with age
(< 0.05).
Conclusions: We could not find any statistically significant
difference in NDI, VAS Neck, and VAS Arm outcomes between
Hybrids and 3 & 4-level cervical disc arthroplasty. In cases
where some levels are contraindicated for arthroplasty,
Hybrids are a viable option.
102
Poster Presentations
(P20)
Comparison of hybrid versus 3 and 4 levels cervical
disc arthroplasty - results from a single centre
Main Author: S Khan
Co Authors: M Rajesh, S Friesem, C Bhatia, G Reddy, K Aneiba
Affiliation: University Hospital of North Tees, Hardwick
Road, Stockton-on-Tees, Cleveland TS19 8PE
Conflicts of Interest: No conflict of Interests
Funding Sources: No funding obtained
Background Context: The term “Hybrid” does not clarify
how many levels of fusion or arthroplasty are in a single
construct. In general terms, it suggests a combination of
both fusions and disc arthroplasty. The clinical outcomes for
Hybrid Cervical Arthroplasty are variable. We did a grouped
retrospective review of prospectively collected data
comparing the outcomes of 3 & 4-level Hybrid procedures
with matched 3 & 4-level Cervical Disc Arthroplasty. All
these procedures were followed for minimum 2 years. The
indications for Hybrid Cervical Arthroplasty were structural
kyphosis and lack of motion at pathologic disc level which
would be a contraindication for arthroplasty
Purpose: To compare the clinical outcome of Hybrid
Arthroplasty with Cervical Disc Replacement at 3 and 4 levels
Study Design/Setting: Retrospective
review
of
prospectively collected data
Patient Sample: 18 Hybrid (Arthroplasty and Fusion)
patients and 51 patients with 3 and 4 levels cervical
arthroplasty
Outcome Measures: NDI (Neck Disability Index), Visual
Analogue score for Neck (VAS Neck) and Visual Analogue
score for Arm (VAS Arm)
Methods: Clinical Outcomes were reviewed on 18 Hybrid
(Arthroplasty and Fusion) patients and 51 patients who had
3 and 4 levels cervical arthroplasty in our unit. Review of
prospectively collected data included NDI (Neck Disability
Index), Visual Analogue score for Neck (VAS Neck), and Visual
Analogue score for Arm (VAS Arm). Scores were collected
pre-operatively and at each follow up at 3 months, 6 months,
1st and yearly afterwards. Two Sample T-test was used to
analyse the data for statistical significance. Results: Mean duration of symptoms was 43 months
for Hybrid patients and 62 months for arthroplasty
patients. NuNec (Pioneer Surgical Technology, USA) and
Discocerv (Alphatec, USA) replacements were used in
Hybrid procedures and 3 & 4-level disc replacements were
performed using Nunec and Prestige (Medtronic, USA).
Hybrid patients had procedures done at 3 & 4-levels. The
indications for surgery were radiculopathy and myelopathy.
One patient had Corpectomy and fixation at C4/5 and C5/6
level with a disc replacement at C6/7 level. The NDI score
improved from a mean of 52.47 to 37.5 for Hybrid patients
and for in the arthroplasty group, it improved from 51.75
to 37.26 (P value: 0.931). The VAS Neck improved from a
mean of 7.06 to 4.08 for Hybrids; from 7.08 to 3.80 (P value:
0.417) for the arthroplasty group. The mean improvement in
VAS Arm scores for Hybrids was from 6.58 to 3.55 and for
arthroplasty, it was 6.55 to 3.77 (P value: 0.898). There was
no statistically significant difference between the 2 groups
(p >0.05) for NDI, VAS Neck and VAS Arm. 103
Conclusions: We could not find any statistically significant
difference in NDI, VAS Neck, and VAS Arm outcomes between
Hybrids and 3 & 4-level cervical disc arthroplasty. In cases
where some levels are contraindicated for arthroplasty,
Hybrids are a viable option.
(P21)
Psychological distress and somatisation does not
affect outcomes in cervical arthroplasty
Main Author: Timothy Hammett
Co Authors: Sandeep Solanki, Richard Ashpole
Affiliation: Department of Neurosurgery, Nottingham
Conflicts of Interest: Richard Ashpole has acted as a
consultant for Alphatec Spine
Funding Sources: No Funding Obtained
Background Context: Psychological distress has previously
been identified as a potential predictor of poor outcomes in
spinal surgery.
Purpose: To define the impact of psychological distress on
outcomes in cervical arthroplasty
Study Design/Setting: Prospective study in a University
Hospital
Patient Sample: Of 75 consecutive patients, 50 completed
questionnaires pre and 12 months post operatively.
Outcome Measures: Neck Disability Index (NDI), Short
Form 36 (SF-36), Modified Zung Self rating depression scale
(Zung), Modified Somatic Perception Questionnaire (MSPQ)
Methods: All patients presenting for cervical arthroplasty
were approached for inclusion.
Results: Of the 50 patients, 40 presented with radicular
symptoms, 9 with myelopathic, and 1 with predominantly
axial pain. After form completion, they were categorised as
per Main et al. ‘Normal’ Patients (19/50) NDI improved from
28.3 to 17.5, SF-36 from 66.7 to 78, those ‘At risk’ (19/50), NDI
improved from 31 to 21, SF-36 from 46.9 to 70.0, Distressed
patients (12/50) NDI improved from 44.5 to 35.6, SF 36
improved from 32.7 to 54.3. Length of stay was similar across
all groups.
Conclusions: All categories benefitted from cervical
arthroplasty. Patients with psychological distress reported
more significant disability and worse quality of life, but still
reported improvements that were maintained at one year.
Non-Operative Treatments
(P22)
Two years following implementation of BSR in a
DGH: perils, problems and PROMS
Main Author: Gorur S Roysam
Co Authors: Anne-Marie Hill, Larry Jagonase, Balaji
Purushothaman, Anthony Cross, Palaniappan Lakshmanan
Affiliation: City Hospital Sunderland, Kayll Road, Sunderland
SR4 7TP
Conflicts of Interest: No Conflict of interest
Funding Sources: No Funding obtained
Background Context: British Spinal Registry (BSR) is a topical
BRITSPINE 2016
Poster Presentations
subject. We are one of the first hospitals in the Northeast
employing BSR in our spinal practice, since June 2013
Purpose: Collection of postoperative data in Spinal surgery
has been challenging and the existing plethora of outcome
measures is a testament to this.
Study Design/Setting: The use of BSR in the hospital was
commenced following a dedicated study day.
Patient Sample: We have collated information on 486 spinal
patients.
Outcome Measures: PROM collection and demographics of
spinal patients.
Methods: BSR information was entered into the Amplitude
website in real time on PCs and IPAD platforms. Patients
entered their data at the weekly `Back-School’.
Results: Of the 486 patients, 78% comprised of lumbar and
14% cervical degeneration, 7% Trauma and remaining were
tumours/infections. Compliance with data entry remains a
problem. NHS number was not recorded in 11%, email-IDs
were not available in 64% and consent was recorded in 53%.
EQ5D was complete in 62% of patients at admission, 20% at
6 weeks and 10% at 6 months. The compliance with ODI was
also similar.
Conclusions: BSR usage is still evolving and lessons are to
be learnt from the early days of NJR. The daily use of spinal
registry falters due to competing clinical demands. The
support for BSR in NHS hospitals is woefully inadequate
and needs to be addressed by the governing bodies for it to
become a useful clinical tool.
(P23)
Rehabilitation following lumbar fusion surgery;
a randomised, controlled, feasibility study with
interim results
Main Author: Jim Greenwood
Co Authors: Alison McGregor (Imperial College, London),
Jen Johnson (UCLH), Kirsty Webley (UCLH), Mike Hurley
(St Georges University of London and Kingston University,
London)
Affiliation: National Hospital for Neurology and
Neurosurgery, Queen Square, London WC13BG
Conflicts of Interest: No conflicts of interest
Funding Sources: NIHR doctoral research fellow awarded to
presenter
Background Context: Following lumbar fusion surgery up
to 40% of patients have ongoing back related disability.
‘Complex rehabilitation’ comprising exercise and cognitive
behavioural therapy (CBT) may help improve outcome. We
are conducting a randomised, controlled, feasibility study
evaluating the provision of ‘complex rehabilitation’ following
lumbar fusion surgery.
Purpose: To present our study protocol and interim results.
Study Design/Setting: Randomised, controlled, feasibility
study: interim results
Patient Sample: n=25
Outcome Measures: Oswestry Disability Index (selfreported disability),
Compliance with protocol
Methods: Participants are randomised to ‘complex
rehabilitation’ or usual care. The ‘complex rehabilitation’
BRITSPINE 2016
protocol involves 10 group sessions (90 minutes duration)
of education (safe and beneficial to exercise, pacing,
managing flare ups, use of analgesia, pain physiology,
thoughts feelings and behaviour), exercise (to improve
limb and spine strength, cardiovascular fitness and range
of movement) and peer support employing principles of
CBT. Usual care involves a single session of inpatient advice
regarding exercise progression with discretionary referral
to physiotherapy. Rehabilitation is commenced 3 months
post op following successful clinical/ radiological review.
A previous exploratory study informed a successful NIHR
application, recruitment commenced July 2014.
Results: Results to date show a greater reduction in ODI from
baseline at 6 months in those randomised to rehabilitation
versus usual care (23 point reduction v 10). Compliance is
excellent (all participants attended >50% sessions).
Conclusions: Interim results suggest a positive effect
favouring ‘complex rehabilitation’ over usual care following
technically successful lumbar fusion surgery suggesting
group rehabilitation in this manner is both acceptable and
safe.
(P24)
Management of paediatric pars oedema without
fracture
Main Author: Vinay Jasani
Co Authors: Santosh Baliga, Safraz Ahmad
Affiliation: Royal Stoke University Hospital, Newcastle Road,
Stoke on Trent ST4 7EW
Conflicts of Interest: None
Funding Sources: None
Background Context: Pars abnormalities are a recognised
cause of paediatric back pain. The management and outcome
of pars oedema without fracture has not been widely
described. We present the clinical features, management
and outcome of this disorder
Purpose: To describe the clinical features, management and
outcomes of children with pars oedema without fracture
Study Design/Setting: Prospective cohort study, secondary
care
Patient Sample: 9 patients
Outcome Measures: VAS at rest; VAS during activity; return
to sport
Methods: All patients with back pain from a children’ s spine
clinic sent for an MRI scan with T1, T2 and STIR sequences
were reviewed for evidence of marrow oedema in the
pars without cortical disruption. VAS scores were recorded
at rest and with activity. The patients were reviewed and
a management strategy of sport shut down for 6 weeks
followed by 6 weeks straight line activity was outlined.
Follow up VAS scores and uninterrupted return to sport was
recorded.
Results: 9 children were identified. All male. 5 cricket, 4
football predominant.
Mean VAS (rest) initial 2
Mean VAS (activity) initial 5.5
Mean VAS (rest) 3 months 0
Mean VAS (activity) 3 months 1.2
Follow up MRI confirmed resolved oedema and no pars
defect in all 9 patients
104
Poster Presentations
Uninterrupted return to sport achieved in all by 6 months
Conclusions: Pars oedema without fracture needs
to be considered in the paediatric population. Short
term shutdown of 6 weeks followed by avoidance of
hyperextension and rotation seems to be sufficient to
reduce the pain and prevent an established pars fracture in
this population.
(P25)
Non-compliance for email responses on the BSR
Main Author: Vinay Jasani
Co Authors: Santosh Baliga, Safraz Ahmad
Affiliation: Royal Stoke University Hospital, Newcastle Road,
Stoke on Trent ST4 6QG
Conflicts of Interest: None
Funding Sources: None
Background Context: The BSR is a web based registry that
collects validated outcome scores. An automated email
facility allows collection of follow up outcome scores. The
email response rate is low leading to loss of data. This paper
presents the reasons for non-compliance.
Purpose: To present the rates of failure of automated email
based outcome questionnaires and patient stated reasons
for non-compliance.
Study Design/Setting: Retrospective review
Patient Sample: 150 random entries
Outcome Measures: Percentage of email uptake,
percentage of responders, reasons for non-compliance
Methods: A random sample of 150 patients uploaded to the
BSR 12 months ago for one unit were reviewed for rates of
consent to email.
The BSR was retrospectively reviewed for responses to email
prompts. Those that failed to respond were contacted by
telephone as a reminder to complete and to determine the
reason for failure.
Results: 80% consented to email (120).
Response rate for the 6 week email was 56.7% (68)
Response rate at 1 year was 48.3% (58)
67.6% (46) of non-responders were contactable.
Reasons for non-response given were:
“Didn’t have time” 34.8% (16)
“Couldn’t open the email” 21.7% (10)
“Email didn’t open on my phone”17.4% (8)
“Didn’t know my NHS number / hospital number” 13% (6)
“I haven’t got any problems” 8.7% (4)
“Wouldn’t let me complete” 4.3% (2)
76% (35) of non-responders requested a paper questionnaire
on contact.
Conclusions: The automated aspect of the BSR has a very
low uptake. Reasons are varied. Most patients requested
paper questionnaires when offered the choice on prompting.
105
(P26)
Spinopelvic dissociation: have we finally got it right?
Main Author: Ibraheim El-Daly
Co Authors: Syed Aftab, Peter Bates, Arun Ranganathan,
Alexander Montgomery
Affiliation: Royal London Hospital, Barts Health NHS Trust,
Whitechapel, London E1 4BB
Conflicts of Interest: None
Funding Sources: None
Background Context: Spinopelvic dissociation (SPD)
is a rare, life threatening condition. With only 63 cases
documented in the literature, evidence is sparse. Joint
operating between spinal and pelvic surgeons at our unit
gives us a unique opportunity to develop a new form of
fixation not previously described.
Purpose: Present our novel reduction manoeuvre, minimally
invasive surgical technique and operative experience, for
the fixation of patients with SPD.
Study Design/Setting: Retrospective cohort study
Patient Sample: Patients presenting with spino-pelvic
dissociation
Outcome Measures: Management technique and outcome
at follow up.
Methods: Retrospective review of 15 cases over 24 months
(2013 – 2015) treated operatively at a level one trauma
centre.
Results: Mean age: 41 years (range 18 – 78) 9 males, 6
females. The most common mechanism of injury was a
fall from height or road traffic accident. Three patients had
known psychiatric illnesses, one of which was a suicide
attempt. Eight patients had other associated injuries and
two had significant neurological deficit at the time of injury
that did not recover. All patients underwent percutaneous
fixation. Eight patients had lumbopelvic fixation reinforced
with an SI screw. Post-operative complications included two
deep surgical site infections over the iliac screw head. Of the
two treated without SI screw fixation one had metal work
failure with loosening of the set screws and dislocation of
the rods bilaterally. There was no mortality.
Conclusions: In our experience, our novel reduction
technique was successful in all patients without any
subsequent loss of reduction or failure of fixation. Triangular
osteosynthesis achieved the most stable fixation without
any failure of fixation or hardware.
(P27)
The development and validation of a test for core
stability
Main Author: Syed Aftab
Co Authors: Tony Betts, Peter Smitham, Ian McCarthy,
Andrew Goldberg
Affiliation: Royal London Hospital, Barts Health NHS Trust,
Whitechapel, London E1 4BB; Royal National Orthopaedic
Hospital, Brockley Hill, Stanmore HA7 4LP
Conflicts of Interest: None
Funding Sources: None
Background Context: Core stability is a concept widely
employed by clinicians and allied health professionals in the
BRITSPINE 2016
Poster Presentations
assessment and treatment of spinal pathology. However, there
is no validated and reliable test for measuring core stability.
Purpose: We aimed to develop a test, which would be
simple, quick, valid and reliable.
Study Design/Setting: Observational Study
Patient Sample: Not applicable
Outcome Measures: Not applicable
Methods: The Delphi method was used. 12 experts working
in the field of core stability (comprised of physiotherapists,
pilates instructors and surgeons) were asked to examine the
core stability of 3 young individuals (including one competitive
athlete, and one sedentary individual). The examinations
were video recorded and each expert underwent a thorough
qualitative interview. The data collected was analysed and
a provisional test was developed. The panel of experts were
presented with this information and the test refined. The
process was repeated until there was agreement among the
panel.
The test was then subjected to thorough validity and interobserver reliability testing with 6 subject and 15 untrained
examiners.
Results: During the initial qualitative assessment it was clear
that no consensus existed on a definition nor test for core
stability.
At the end of the Delphi Process we developed a 14 point
test which took on average 90 seconds to complete. The
test exhibited strong inter-observer reliability (Intraclass
Correlation 0.89) and intra-rater reliability (Pearson’s
correlation coefficient 0.91).
Conclusions: We have produced a simple yet valid and
reliable test for core stability that requires little training and
can be used in research and clinical practice by surgeons,
physicians, physiotherapists and allied health professionals
(P28)
Vitamin D deficiency and the association with
higher rates of surgical intervention
Main Author: Syed Aftab
Co Authors: Onyinye Akpenyi, Christian Smith, Murat Faik,
Leo Denning, Arun Ranganathan, Alexander Montgomery
Affiliation: Royal London Hospital, Barts Health NHS Trust,
Whitechapel, London E1 4BB
Conflicts of Interest: None
Funding Sources: None
Background Context: It is widely thought that a link between
low vitamin D levels and symptomatic spinal pathology exists.
450 patients with low vitamin D were identified and analysed
for any link between low vitamin D and need for intervention
compared a matched cohort with normal vitamin D.
Purpose: To investigate if there is a positive correlation
between low vitamin d and intervention in symptomatic
spinal pathology.
Study Design/Setting: Retrospective cohort study
Patient Sample: All patients with low vitamin d and spinal
intervention
Outcome Measures: Requirement for spinal surgery or
injection.
Methods: A retrospective analysis of patients seen in a spine
clinic in a major institution over two years was undertaken.
BRITSPINE 2016
Patients were selected if they had low vitamin D. Findings
were compared to age, sex and pathology matched controls.
Demographics and type of intervention were analysed
Results: 450 patients with low vitamin D were identified.
180 patients (40%) had either spinal surgery or injections,
compared to controls which had only 15% (chi squared p
value 8E-06 - significant, <0.05). The average Vitamin D level
was 42.3 nmol/L. This was greater in the injection group
(40.7 nmol/L), and lower in the surgery group (31.85 nmol/L).
The average age was 52 years (injections: 53, surgery: 47).
The majority of patients had caudal epidurals and lumbar
facet injections. The commonest surgical intervention was
decompression followed by fusion.
Conclusions: The commonest procedure in patients with
low vitamin D was injections (older population and higher
vitamin D). Those undergoing surgery were younger and
had lower vitamin D levels, perhaps due to comorbidities.
Further analysis into outcomes will be made.
There is a positive link with low vitamin D and the requirement
for spinal intervention. This confirms the need to normalise
levels before any intervention is planned for in spinal patients.
(P29)
The effect of fluid flow on intervertebral disc cells
Main Author: Cate Wilson
Co Authors: Tom Joyce, Phil Hyde, Mark Birch, Kenneth
Rankin, Ria Toumpaniari, Simon Partridge
Affiliation: Newcastle University, Stephenson Building,
Claremont Road, Newcastle University, Newcastle-UponTyne NE1 7RU
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Spinal exercises are recommended
by NICE guidelines for the treatment of low back pain but
research surrounding which exercises are most beneficial
has been inconclusive. Spinal movement creates pressure
change and fluid flow which is essential for disc health.
Purpose: Investigating how IVD cells react to different fluid
flows and determining which exercises are most effective for
disc health would be beneficial to clinicians and patients.
Study Design/Setting: The effect of ten flow rates on
gene expression in bovine IVD cells was tested. Each flow
was repeated four times with four samples in each run and
controls with no flow were tested simultaneously.
Patient Sample:
Outcome Measures:
Methods: Bovine cells were seeded onto Ibidi Leur VI0.4
slides and introduced to fluid flow rates ranging from 0.1ml/
min to 8ml/min compared to a control with no flow. Gene
expression including aggrecan, collagen, aggrecanase and
collagenases were analysed using real time PCR.
Results: Preliminary results demonstrated statistically
significant catabolic changes in flow rates above 0.3ml/min,
no effect on gene expression at 0.2ml/min and anabolic
changes at 0.1ml/min.
Conclusions: Bovine IVD cells are responsive to different
fluid flow rates. Further investigation of flow rates below
0.1ml/min, protein expression in cells and in the culture
supernatant, bovine cells in 3D culture and studies using
human cells are planned.
106
Poster Presentations
Spinal Deformity
(P30)
Upright, prone and supine spinal morphology in
adolescent idiopathic scoliosis
Main Author: Rob Brink
Co Authors: Tom Schlösser, Dino Colo, Koen Vinken, Marijn
van Stralen, Steve Hui, Winnie Chu, Jack Cheng, René
Castelein
Affiliation: 1Department of Orthopaedic Surgery, UMC
Utrecht, Utrecht, The Netherlands; 2Image Sciences Institute,
UMC Utrecht, G05.228, P.O. Box 85500, 3508 GA Utrecht,
The Netherlands; 3Department of Imaging & Interventional
Radiology, Prince of Wales Hospital, CUHK, Hong Kong;
4Department of Orthopaedics and Traumatology, Prince of
Wales Hospital, CUHK, Hong Kong
Conflicts of Interest: No conflicts of interest
Funding Sources: Medtronic Research Grant, K2M Research
Grant, Foundation Yves Cotrel Start Up Grant, Alexandre
Suerman MD PhD Stipendium, UMC Utrecht
Background Context: Adolescent idiopathic scoliosis
(AIS) patients are exposed to ten times more radiation as
compared to healthy adolescents, this leads to an increased
risk of developing malignancies. In order to minimize the
radiation exposure, non-ionizing imaging modalities (MRI)
can be used.
Purpose: To evaluate the correlation between the
morphology of the spine on conventional radiographs and
3-D scans (prone CT and supine MRI) in AIS.
Study Design/Setting: Cross-sectional
Patient Sample: 62 AIS patients had undergone standard
pre-operative work-up (upright radiographs, supine MRI
and prone CT).
Outcome Measures: Cobb angles, thoracic kyphosis,
lumbar lordosis and apical vertebral rotation (2-D: Perdriolle,
3-D: semi-automatic software)
Methods: In all positions, the outcome measures were
determined. Furthermore, on reconstructed 3-D MRI CTscans, the true sagittal and coronal morphology were
measured semi-automatically (previously validated).
Results: In the thoracic and (thoraco) lumbar curves, Cobb
angles correlated between radiographs (68±15° and 44±17°),
supine MRI (57±14° and 35±16°) and prone CT (54±15° and
33±15°; r≥0.89; P<0.001). The rotation showed a correlation
between the positions (upright, 22±12°; prone, 20±9° and
supine, 16±11°; r≥0.56; P<0.001). The thoracic kyphosis and
lumbar lordosis on X-rays did not correlate with the true
sagittal morphology on MRI or CT.
Conclusions: Although the underestimation of the
morphology of the 3-D spinal curvature in the supine
position as compared to upright, there is a significant
correlation of the deformation in the different positions and
imaging modalities. Therefore, accurate estimation of the
upright morphology of AIS is possible, using non-ionizing
supine MRI or prone CT.
107
(P31)
The effect of magnetically controlled growing
rod on the sagittal profile in early-onset scoliosis
patients
Main Author: Behrooz Akbarnia
Co Authors: Kenneth Cheung, Kenny Kwan, Dino Samartzis,
John Ferguson, Chrishan Thakar, Pavlos Panteliadis, Colin
Nnadi, Ilkka Helenius, Muharrem Yazici, Gokhan Halil
Demirkiran, Ahmet Alanay
Affiliation: San Diego Center for Spinal Disorders, La Jolla,
California, USA
Conflicts of Interest: None to declare
Funding Sources: Ellipse Technology
Background Context: Magnetically controlled growing
rods (MCGR) have a straight central housing portion that
cannot be bent. The effects of gradual lengthening on the
regional and overall sagittal profile in early onset scoliosis
(EOS) are unknown.
Purpose: Report on the changes of the sagittal profile after
MCGR implantation.
Study Design/Setting: Retrospective multicentre study
with a minimum 2 year follow up
Patient Sample: Consecutive patients with EOS undergoing
MCGR treatment
Outcome Measures: Clinical and Radiological
Methods: Retrospective review of prospectively collected
data from consecutive patients undergoing MCGR treatment
with minimum 2-year follow-up from 6 centres. Clinical data
and complications noted. Radiographic measurements thoracic kyphosis (TK), lumbar lordosis (LL) and sagittal
vertical axis (SVA) were analysed.
Results: 30 patients were reviewed and 23/30 had full
radiographic data for analysis. The mean age at time of
surgery was 7.3 years (range: 4-14 years) and mean follow-up
period was 39.2 months (range: 24- 61 months). Patients were
divided into 3 groups according to pre-operative TK: group
1 (TK<20°), group 2 (TK 20°-40°) and group 3 (TK>40°). Mean
TK did not change in group 1 or 2 during MCGR lengthening
but decreased in group 3, and mean LL remained the same
in all 3 groups. At final follow-up, global sagittal balance (SB)
improved or returned to neutral alignment in 60% of cases,
and did not change in 27%, and worsened in 13%.
Conclusions: This study showed that MCGR reduced TK in
those with pre-existing TK >40° and had no effect on other
regional sagittal parameters. It had a tendency to improve
the global sagittal balance.
(P32)
Intrathecal baclofen pumps do not accelerate
progression of scoliosis in quadriplegic spastic
cerebral palsy
Main Author: Paul Rushton
Co Authors: Luigi Aurelio Nasto, Ranjit Aujila, Michael
Vloeberghs, Michael Grevitt
Affiliation: Centre for Spinal Studies and Surgery, Queens’s
Medical Centre, Nottingham
Conflicts of Interest: No conflicts of interest
BRITSPINE 2016
Poster Presentations
Funding Sources: No funding obtained
Background Context: The literature is unclear whether
intrathecal baclofen (ITB) pumps accelerate scoliosis
progression in cerebral palsy.
Purpose: Compare scoliosis progression in quadriplegic
spastic cerebral palsy with and without ITB pumps.
Study Design/Setting: Retrospective matched cohort
Patient Sample: Quadriplegic spastic cerebral palsy, GMFCS
level 5, follow up >1 year
Outcome Measures: Physiologic measures:
Primary: Annual coronal curve progression
Secondary: Peak coronal curve and pelvic obliquity
progression. Need for spinal fusion
Methods: Suitable patients with ITB pumps were matched
to comparable cases by age and baseline Cobb angle
without ITB pumps.
Results: ITB group: 18 patients (8 female), mean age at pump
insertion 9.8 and Risser 0.9. Initial Cobb angle 24° and pelvic
tilt 1.3°. Follow up 4.5 (1.0-7.8) years. Cobb angle at follow up
77° and pelvic tilt 20°.
Non-ITB group: 18 patients (10 female), mean age at baseline
9.7 and Risser 1.1. Initial Cobb angle 28° and pelvic tilt 6°.
Follow up 3.6 (1-7.5) years. Cobb angle at follow up 68° and
pelvic tilt 20°.
The two groups were statistically similar for age, initial Cobb
angle and Risser grade.
Mean curve progression was 12.8°/year for the ITB group
vs 12.9°/year for the non-ITB group (p=0.8). Peak curve
progression was similar between the groups. Pelvic tilt
progression was comparable; ITB group 4.7°/year vs non-ITB
4.6°/year (p=0.97). 5 ITB and 6 non-ITB patients had spinal
fusion surgery during follow up.
Conclusions: Patients with quadriplegic spastic cerebral
palsy with and without ITB pumps showed significant curve
progression over time. ITB pumps do not appear to alter the
natural history of curve progression in this population.
(P33)
Sacro-pelvic fixation using S2 alar-iliac (S2AI) screws
- analysis of clinical and radiological outcomes with
minimum 1 year follow-up
Main Author: Sheba Basheer
Co Authors: Peter Loughenbury, James Tomlinson, Robert
Dunsmuir, Nigel Gummerson, Almas Khan, Abhay Rao, Peter
Millner
Affiliation: Leeds General Infirmary, Great George Street,
Leeds LS1 3EX
Conflicts of Interest: No conflicts of interest.
Funding Sources: No funding obtained.
Background Context: Sacro-pelvic fixation with iliac screws
requires transverse connectors and is associated with risks
of prominent metalwork, pelvic pain, pressure necrosis
and construct failure. Significant lateral dissection leads to
greater risk of bleeding and infection. The S2 alar-iliac (S2AI)
screw has been suggested as an alternative to reduce these
risks.
Purpose: To report the clinical and radiological outcomes of
pelvic fixation using the S2AI technique in our unit.
BRITSPINE 2016
Study Design/Setting: Single centre retrospective review.
Patient Sample: 21 consecutive patients undergoing sacropelvic fixation using the S2AI technique.
Outcome Measures: Physiologic (radiological parameters)
and self-reported (clinical outcomes).
Methods: Patients undergoing sacro-pelvic fixation using
S2AI screws (January 2012 to October 2014. Clinical data
from follow-up with radiographs at 6 months and 1 year.
Results: 21 patients with mean age 61 years (range 1484). 13 were revision procedures with extension to the
pelvis (including 3 three-column osteotomies for sagittal
imbalance). 8 cases were primary procedures for adult
deformity correction (3), infection (2), fracture (1), metastatic
collapse (1) and syndromic scoliosis (1). One patient died
due to complications of malignant disease.
20 patients were followed up for one year or more. There was
one case of improper screw placement (sciatic notch breech
– revised at 4 weeks). One patient experienced posterior
pelvic pain. There were two cases of deep infection requiring
further surgery and one case of aseptic screw loosening.
There were no cases of screw breakage or pseudoarthrosis.
Conclusions: The S2AI technique is a safe and reliable
method of sacro-pelvic fixation. Early results from our series
suggest that it associated with a low rate of complications.
(P34)
Two stage anterior/posterior scoliosis deformity
correcting surgery is a powerful tool in selective
lumbar fusion for stiff double major curves by
saving distal motion segments
Main Author: H Yu
Co Authors: D Lui, A Benton, E Carter, J Leong, J Lehovsky, M
Shaw, S Molloy, A Gibson
Affiliation: Department of Spinal Disorders and
Neurophysiology, Royal National Orthopaedic Hospital,
Brockley Hill, Stanmore, Middlesex HA7 4LP
Conflicts of Interest: No conflicts of interest
Funding Sources: Nil
Background Context: Selective proximal lumbar fusion
has clinical benefits to the patient. It is recognised that the
inherent flexibility of the main thoracic (MT) curve in scoliosis
is a significant predictor of final outcome of single major
curves. A supine bending radiograph (SBR) can be utilised
to stratify the flexibility of the thoracolumbar (TL) and MT
curves in double major adolescent idiopathic scoliosis (AIS).
Utilising a two stage anterior/posterior technique can save
lumbar motion segments by choosing a more proximal
“lowest instrumented vertebra” (LIV) compared to the
traditional Harrington stable vertebra (HSV).
Purpose: We compared the actual distal LIV and the
considered HSV across a novel method of stratification into 4
categories of flexibility for double major curves to assess the
ability of a front/back 360 ̊ procedure to ensure a selective
lumbar fusion.
Study Design/Setting: Retrospective radiographic review
Patient Sample: 2314 consecutive scoliosis deformity
correcting surgeries from 2006 to 2012 with minimum 2
year follow up identifying all AIS with front / back two stage
surgery and stratified by Kings Classification.
108
Poster Presentations
Outcome Measures: Not applicable
Methods: Preoperative demographics. Preoperative:
standing radiograph Cobb, Harrington Stable Vertebra,
Supine Bending Radiograph (SBR) Cobb. Postoperative
radiographs: Correction Rate (CR), Supine Bend Flexibility
(SBF) and Supine Bending Flexibility Index (SBFI), LIV
intervertebral cobb. Mean HSV was compared to actual LIV.
Stratification of flexibility into quartiles and non-parametric
independent samples Kruskal Wallis Test to compare means
across the novel classification.
Results: 58 anterior/posterior King 1&2 AIS (2.6%). 82%
female, mean age 14.5y. Preoperative Cobb Main Thoracic
(MT) 62.7 ̊, Thoracolumbar (TL) 59.1 ̊, Flexibility 31.8%
(MT), 50.4% (TL). Postoperative CR was 68.6% (MT), 79.3%
(TL). SCBI of 277.9% (MT), 177.9% (TL). The mean HSV 4.63,
mean LIV 3.1. LIV intervertebral Cobb 4.57 ̊. Quartiles
for flexibility: 4th (>64%), 3rd (53-64%), 2nd (39-53%), 1st (039%). Non parametric testing rejects the null hypothesis
for postoperative parameters CR TL, SBCI TL and FTL and
intervertebral cobb of LIV (p <0.05) across all categories of
flexibility. The null hypothesis is retained comparing the
distribution of HSV (p = 0.744) and LIV (p = 0.548) across all
categories of flexibility.
Conclusions: We validated our novel approach to
stratifying the flexibility of thoracolumbar curves by supine
bending radiograph showing significant differences across
stratification of flexibility. The HSV, LIV and mean numbers
of level saved showed no significant difference comparing
the stiffest curves to the most flexible. This result shows
the independent power of a two stage anterior/posterior
procedure for correction of double major curves regardless
of stiffness and flexibility.
(P35)
Radiographic outcomes and adverse events
following surgical intervention for adult spinal
disease using the novel, low-profile, enhanced
rigidity spinal beam (ERSB) system
Main Author: Matthew E Cunningham
Co Authors: Oheneba Boachie-Adjei, Shyam Kishan, Dennis
Knapp, Mark Rahm, Stewart Tucker, Virginie Lafage, John
Kostuik
Affiliation: Hospital for Special Surgery, 535 East 70th Street,
New York 10021, USA
Conflicts of Interest: Speaking and/or Teaching
Arrangements: DePuy/J&J (Stipend)
Funding Sources: K2M Inc
Background Context: Implants for correction of Adult
Spinal Deformity (ASD) like the Enhanced Rigidity Spinal
Beam (ERSB) system have been designed to improve power
of correction in the sagittal plane.
Purpose: Evaluate outcomes and complications from a low
profile ERSB system.
Study Design/Setting: Retrospective review/multicenter
database
Patient Sample: 61 ASD patients
Outcome Measures: Cobb values: upper thoracic, thoracic,
thoracolumbar, lumbar, and max Cobb and adverse events
(AEs).
Methods: Radiographic evaluations included coronal and
109
sagittal, pre-op and follow- up (avg: 12 months). Pre- to
post-operative changes in coronal and sagittal spino-pelvic
parameters were investigated using paired t-test analysis.
Results: Surgical intervention resulted in significant
decrease in Cobb values: upper thoracic (20.2/27.2°),
thoracic (28.8/47.8°), thoracolumbar (28.5/56.0°), lumbar
(15.0/33.5°), Max Cobb (31.3/50.0°), all p<0.05. Sagittal
analysis revealed significant decrease in SVA (47.8/71.8mm,
p=0.009) but no change in pelvic incidence, pelvic tilt, PI-LL,
thoracic kyphosis, or T1 pelvic angle. Hypo-kyphotic patients
(<20°) increased kyphosis (2.4/20°), normally kyphotic
patients increased kyphosis (25 vs. 32°) and decreased
in PI-LL mismatch (7/13°), and hyperkyphotic patients
(>40°) decreased kyphosis (47/63°), all p<0.05. AEs (avg:
1.34/patient) included excessive pain (25%), neurological
events unresolved prior to final follow up (11.5%), proximal
junctional kyphosis (6.6%), 2 broken rods (3.3%), 2 pleural
effusions and 1 pneumothorax. 27.9% of patients returned
to the OR including 19.7% for a revision, 6.6% for reoperation
and 1.6% for hardware removal.
Conclusions: The ERSB provides comparable coronal
correction in ASD surgeries, and may help to better obtain
and maintain corrections in the sagittal plane than other
systems. Complications using the novel ERSB system are
comparable to those observed using alternate systems.
(P36)
Circumferential staged open L4-S1 posterior
reduction, S1 dome osteotomy followed by miniopen anterior lumbar inter-body fusion using
bone morphogenic protein (BMP-2) for high grade
lumbosacral isthmic spondylolisthesis (HGLIS)
Main Author: Erlick Pereira
Co Authors: Arish Rehman, Khai Lam
Affiliation: Guy’s and St Thomas’ Hospitals NHS Foundation
Trust, London SE1 9RT
Conflicts of Interest: None
Funding Sources: None
Background Context: HGIS requires challenging surgery.
Circumferential interbody fusion is biomechanically
advantageous, combining large endplate surface area
allowing torsional stability and better fusion.
Purpose: To evaluate outcomes of L4-S1 open pedicle screw
reduction, S1 dome osteotomy followed by mini-open
anterior lumbar interbody fusion (ALIF) using (BMP-2).
Study Design/Setting: Consecutive case series
Patient Sample: 4 females and 1 male, mean age 25 years
(range 14-39).
Outcome Measures: Self-report measures: ODI, pain VAS.
Radiological measures: lumbosacral slip (LS), slip angle
(SA), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI),
segmental lordosis (SL), lumbar lordosis (LL), and CT to
assess fusion.
Methods: Clinical measures and standing spinal radiographs
were collected before surgery and minimum 12 months
follow-up. Radiological measures were calculated using
Surgimap (Nemaris Inc).
Results: Mean preoperative radiological parameters were
LS 60% (s.d. 13%), SA 10° (s.d. 10), SS 54° (s.d. 20), PT 26°
(s.d. 12), PI 80° (s.d. 11), SL 28° (s.d. 17), LL 58° (s.d. 17). The
BRITSPINE 2016
Poster Presentations
following mean improvements were seen 12 months after
surgery: LS 34%, SA 28%, SS 7%, PT 19%, PI 12%, SL 11%,
LL 10%. All patients showed complete fusion on CT at 6
months following surgery. At one year follow-up, back VAS
improved by 64% and leg VAS 73%. One patient developed
urinary sepsis but there were no other complications. Mean
time between surgeries was 7.4 days and hospital stay 9.2
days.
Conclusions: This staged circumferential operation is safe,
effective and achieves solid fusion with no neurological
injury. Larger case series and longer-term follow-up are
desirable.
(P37)
Accuracy of pre-operative surgical planning
software in predicting postoperative alignment in
patients undergoing minimally invasive multilevel
anterior column reconstruction for positive sagittal
balance deformity
Main Author: Robert Lee
Affiliation: Royal National Orthopaedic Hospital, Brockley
Hill, Stanmore HA7 4LP
Conflicts of Interest: No conflict of interest
Funding Sources: None
Background Context: Sagittal realignment in adult
deformity surgery is crucial. Patients can present with an
obvious increase in Sagittal Vertical Axis (SVA) or have a
hidden sagittal balance problem with a normal SVA but high
pelvic tilt (compensated balance). Software is available to
measure patient alignment parameters and to simulate the
operation. Anterior column reconstruction using multiple
anterior cages inserted via a minimally invasive lateral or
anterior technique may provide a reliable way of executing
the pre-operative plan.
Purpose: To compare the final and predicted sagittal
alignment parameters in patients undergoing minimally
invasive anterior column realignment
Study Design/Setting: Retrospective
review
of
prospectively collected data
Patient Sample: Single surgeon case series of 30 patients
with positive sagittal balance (both compensated and
uncompensated including 21 degenerative scoliosis, 9
spondylolisthesis, 8 iatrogenic flat back, 9 proximal level
degeneration).
Outcome Measures: Comparison of the following predicted
and final parameters: Lumbar lordosis (LL), Pelvic Incidence
– Lumbar Lordosis mismatch (PI-LL), SVA and Pelvic Tilt (PT).
Methods: Surgimap was used to measure parameters and
surgery simulated using multilevel lateral or anterior cages.
Pelvic tilt was then adjusted to normal values for each pelvic
incidence to determine the predicted SVA. Predicted results
were compared to the final outcome.
Results: Surgimap planning was accurate to within 30.43mm
for SVA (-90.9 - 55.4mm; median 20.54mm), 5 degrees for LL
(0-20 degrees; median 4 degrees), 5 degrees for PI-LL (-20 –
11 degrees; median 5 degrees) and 6 degrees for PT (0 – 23
degrees; median 4 degrees).
Conclusions: Surgical planning software provides a reliable
way of predicting alignment outcomes in anterior column
reconstruction surgery.
BRITSPINE 2016
(P38)
The use of transitional flexible rods in long posterior
instrumentation to correct adult degenerative
kyphoscoliosis - short term results
Main Author: Giuseppe Lambros Morassi
Co Authors: Roozbeh Shafafy, Bronek Maximilian Boszczyk,
Masood Shafafy
Affiliation: The Center for Spinal Studies and Surgery,
Nottingham
Conflicts of Interest: Nil
Funding Sources: Nil
Background Context: Proximal Junctional Kyphosis
(PJK) and Proximal Junctional Failure (PJF) are recognised
complications of long segment instrumentation for the
correction of adult spinal deformity
Purpose: To evaluate the short term results of hybrid
systems that combine flexible and rigid rods in the surgical
corrective treatment of patients with adult deformity.
Study Design/Setting: Retrospective analysis of eight adult
patients
Patient Sample: Eight female patients (mean age 56.8
years) had surgery for correction of adult spinal deformity
with instrumentation from the thoracic spine to sacrum or
pelvis.
Outcome Measures: Preoperative ODI and VAS scores
were performed and compared to postoperative scores.
Postoperative radiographs after surgery were reviewed for
any signs of PJK (defined as proximal junctional cobb angle
increase >10°)
Methods:
Eight
patients
underwent
posterior
instrumentation in order to correct severe adult degenerative
kyphoscoliosis. The surgery included long instrumentation
combined with the use of a hybrid rod technique with
a dynamic rod system at the upper most instrumented
segments in order to create a transitional area between the
rigid fused distal spine and the uninstrumented proximal
spine
Results: Mean follow up was 14 months (9-25 months). In
all patients there were no radiographic signs of metalwork
failure, PJK or PJF. There was a significant improvement in
both ODI and VAS scores at latest follow up.
Conclusions: The use of transitional flexible rods in order to
create a zone of soft landing in adult deformity correction
surgery has promising short term results in our experience
(P39)
Influence of three different surgical instruments on
total blood loss in pedicle subtraction osteotomy
Main Author: Roozbeh Shafafy
Co Authors: Giuseppe Lambros Morassi, Nasir Qureshi,
Masood Shafafy
Affiliation: Centre for Spinal Studies and Surgery, Queens
Medical Centre, Derby Road, Nottingham NG7 2GY
Conflicts of Interest: None
Funding Sources: None
Background Context: Excessive blood loss has been
110
Poster Presentations
reported as one of the most common complications of three
column osteotomies in Adult spinal deformity surgery. Blood
loss in turn will lead to secondary complications. Surgical
techniques which reduce blood loss may have a positive
impact on patient recovery.
Purpose: The aim of this study is to evaluate the effect
of three different pedicle subtraction (PSO) osteotomy
techniques on the total blood loss.
Study Design/Setting: Retrospective evaluation of total
blood loss (TBL) in three groups of patients who had
undergone PSO with different techniques all performed by
the senior author
Patient Sample: Group 1: 5 patients (4F, 1M), average age
56.4 (49-63). Group 2: 5 patients (4F, 1M), average age 62 (5668). Group 3 : 5 (4F, 1M), average age 60 (42-75). All patients
had degenerative or late post-traumatic kyphoscolioisis
and underwent single level PSO and long posterior
instrumentation.
Outcome Measures: Operative TBL, surgical time,
postoperative drainage and length of stay in HDU/ITU were
evaluated.
Methods: In performing PSO, non-specialised general
instruments was used for group 1, Dedicated osteotomy kit
was used for group 2 and dedicated osteotomy kit combined
with Ultrasonic bone scalpel for group 3.
Results: There was a significant difference in the operative
TBL between all three groups with the first group having
the highest and the third group the lowest. There was
no significant difference in other parameters measured
between the groups.
Conclusions: Dedicated osteotomy kit combined with
Ultrasonic bone scalpel may help to reduce the total blood
loss in complex spinal osteotomies.
(P40)
Evaluating the sagittal spinal and pelvic parameters
in Marfan syndrome patients affected with scoliosis
Main Author: Sukrit Suresh
Co Authors: Adam Margalit, Paul D Sponseller
Affiliation: Guy’s, King’s and St Thomas’ School of Medicine,
Academic Centre, Henriette Raphael House, London Bridge,
London SE1 1UL
Conflicts of Interest: none
Funding Sources: none
Background Context: Spinal deformities present a
common finding in patients affected with Marfan Syndrome
(MFS). More specifically, sagittal spine imbalances reflect the
typical finding of such deformities within this population.
Observing the spinal radiographs of such patients, we
focused on eliciting any correlation between the pelvic
incidence (PI) and thoracolumbar kyphosis measurements,
and categorising them according to a sagittal spinal
classification system.
Purpose: The current literature on this subject focuses more
on the prevalence of lateral scoliosis in patients with Marfan’s
rather than appreciating the larger, three dimensional
effects that this condition has on the spine.
Study Design/Setting: N/A
Patient Sample: N/A
Outcome Measures: N/A
111
Methods: We explored the Johns Hopkins Hospital database
for the records of MFS patients consulted over the past 6
years (2009 - 2015). 170 patients were extracted; further
refined to incorporate a total of 44; 25 males and 19 females
with an average age of 20 y/o at imaging.
Results: The mean PI values for each sagittal class were as
follows:
type 1A - 53°, type 1B - 42°, type 1C - 36°, type 2A - 39°, and
type 2B - 35°.
Our analysis revealed statistically significant differences
between type 2A & 1A spines (P = 0.04), and type 1A
& 1C spines (P = 0.02). In particular, the type 2A spines
demonstrated a mean PI that was 14.9° less than in the
unaffected population.
Conclusions: We have demonstrated how pelvic incidence
affects sagittal curvatures of the thoracic and lumbar spine
in patients with Marfan’s Syndrome and wish to highlight
the correlated patterns that occurred when comparing
these two parameters.
Spinal Infection
(P41)
A novel technique for the diagnosis of spinal
implant infection
Main Author: Giuseppe Lambros Morassi
Co Authors: Roozbeh Shafafy, Waheed Ashraf, Roger
Bayston, Masood Shafafy
Affiliation: The Center for Spinal Studies and Surgery,
Nottingham, Biomaterials-Related Infection Group School
of Medicine University of Nottingham
Conflicts of Interest: None to declare
Funding Sources: None to declare
Background Context: Infection of metalwork is a recognised
and significant complication of instrumented spinal
procedures. Identification of the causal microbial pathogen
is of paramount importance to successful treatment.
Purpose: The aim of this study is to outline the use of
sonication fluid cultures derived from explanted spinal
implants in the absence of positive tissue cultures
Study Design/Setting: A retrospective analysis of three
patients who developed late infection after surgery for
correction of spinal deformity
Patient Sample: 2 patients (1 M: 1F) underwent surgery for
correction of adult scoliotic deformity and 1male patient for
correction of Scheurmann’s kyphosis
Outcome Measures: Cultures and biochemical markers of
inflammation were monitored.
Methods: All patients underwent wound washout and
removal of infected metalwork. Explanted pedicle screws
were sonicated and fluid cultures were examined. In
addition tissue specimens (>5) were collected and cultured
according to standard practice. All patients completed a
course of prolonged antibiotic treatment on the basis of
sonication cultures with subsequent reinstrumentation
Results: In all three cases routine tissue culture alone or even
PCR did not yield any pathogen. Sonication fluid cultures,
however, yielded Staphylococcus aureus and Escherichia
BRITSPINE 2016
Poster Presentations
coli in one case, Corynebacterium propinquum in one
patient and Corynebacterium tuberculostearicum in the
third patient. In all three cases the infection was successfully
treated with wound washout exchange of metalwork and
antibiotics. There were no signs of deep wound infection
after the reinstrumentation up to the latest follow up
Conclusions: In cases where standard tissue culture fails
to yield a result, sonication of explanted metalwork and
culture of sonicated fluid may be a useful tool to ascertain
the causative microorganism.
Spinal Trauma
(P42)
Acute clinical outreach for spinal cord injuries service evaluation study
Main Author: Naveen Kumar Co Authors: Alison Lamb
Affiliation: Robert Jones and Agnes Hunt Orthopaedic
Hospital, Oswestry
Conflicts of Interest: None
Funding Sources: None
Background Context: MCSI has been providing acute
clinical outreach, including a comprehensive report
following assessment of patients with Spinal Cord Injury
(SCI) for the Trauma Network in Midland region.
Purpose: Test the quality of assessments and treatment
advice given to Trauma Units and Major Trauma Centres
in order to improve patient care and outcomes based on
national acute SCI pathway.
Study Design/Setting: Retrospective cohort study/
Regional Spinal Injuries Centre
Patient Sample: All SCI referred over 7 months, since
commencement of UK National SCI Database (NSCIDB).
Outcome Measures: Compliance with National SCI
Standards (> 90% outreach visits to new SCI patients within
5 working days) and satisfaction of service users.
Methods: Qualitative and quantitative analysis on the
assessment, advice and documentation by outreach team.
Data collected from Electronic-Patient-Record and NSCIDB.
A purpose designed questionnaire was sent and analysed
with Survey Monkey, an online service.
Results: 70 patients were referred via NSCIDB. 53 patients
were assessed within 5days, rest were admitted within 7days.
14 patients had developed Grade-2 and above pressure ulcer.
32 users completed the questionnaire, including-2(6.9%)
Orthopaedic surgeons, 1(3.4%) Neurosurgeon, 2(6.9%)
Rehabilitation-Physicians, 12(41.4%), Nurses, 11(37.9%)
Physiotherapists and 2Trauma Co-ordinators. 93% of them
responded that Outreach team identified and discussed
management of SCI complications. All responded positively
to advice given on bowel, bladder and skin management,
positioning of the patient, speed of response and written
treatment plan. 38.5% were extremely and 30.8% were
moderately satisfied with outreach service.
Conclusions: MCSI acute clinical outreach service is
compliant with NSCISB guidelines and is providing a high
quality service to Trauma Network in the Midland region.
BRITSPINE 2016
(P43)
Mortality within a year of discharge following
holistic spinal cord injury management
Main Author: Naveen Kumar Affiliation: Robert Jones and Agnes Hunt Orthopaedic
Hospital, Oswestry
Conflicts of Interest: None
Funding Sources: None
Background Context: Increasing incidence of death (within
one year) has been observed in patients with Traumatic
Spinal Cord Injury (TSCI) following holistic management.
Purpose: To evaluate epidemiological and aetiological
factors contributing to early mortality in persons with TSCI.
Study Design/Setting: Retrospective cohort study/
Regional Spinal Injuries Centre
Patient Sample: SCI related complications and determinants
of mortality.
Outcome Measures: Outcome comparison of conservative
Vs Operative management and SCI related complications
Methods: Data collected retrospectively from MCSI
Database, National SCI Database, MCSI complication register,
Electronic-Patient-Records of all patients with TSCI between
Jan-2011 to Dec-2013 were analysed. Data collected on
demographics, personal and lesion characteristics of all
patients. Information on cause of death was obtained from
GP and post-mortem reports.
Results: 4.1% (15/365) of TSCI patients died within 1 year
of discharge. Mean age in this group was 65.3(range 46-84)
years compared to 51.0 years among survivors. 9 patients
had a lesion of C5 level or higher and 10 had motor complete
(AIS-A or B) paralysis. All patients had at least 2 pre-existing
cardiorespiratory co-morbidities. Respiratory infection was
seen in 14 patients, 6 required transfer to HDU and 6 required
transfer to another hospital. The cause of death was heart
failure in 5, sepsis in 2 and pneumonia in 1. Mean survival
since TSCI in deceased group was 0.87 years (range 0.17 to
1.53). The discharge of 6 patients was delayed pending CHC
approval. 80% patients were discharged to either nursing
home or another hospital.
Conclusions: Significant determinants of early mortality
were older age, co-morbidities, lesion at C5 or above, motor
complete lesion and discharge destination.
(P44)
Vertebral augmentation for vertebral fractures in
the ‘older-old’ person: experience from a tertiary UK
spinal unit
Main Author: Ashok Kumar
Co Authors: Lucy Simmonds, Terence Ong, Opinder Sahota
(Department for Healthcare of Older People, Nottingham
University Hospitals NHS Trust), Wai Weng Yoon, Nasir
Quraishi (Centre for Spinal Studies and Surgery, Nottingham
University Hospitals NHS Trust)
Affiliation: Queens Medical Centre, Nottingham University
Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
112
Poster Presentations
Background Context: Vertebral augmentation has been
shown to improve pain associated with osteoporotic
vertebral fractures (VF). Its benefit in the ‘older-old’ is less
certain.
Purpose: Assess outcomes in this cohort post-augmentation.
Study Design/Setting: Cross-sectional analysis of patients
admitted for augmentation to a UK tertiary spinal unit.
Patient Sample: 25 patients ≥80yrs admitted for
augmentation for pain due to clinical osteoporotic VF over
a 24 month period.
Outcome Measures: Patient characteristics, visual analogue
scale (VAS), Oswestry Disability Index (ODI), analgesic
requirements and healthcare outcomes.
Methods: Data was extracted from a combination of case
notes and electronic hospital held records.
Results: Patients’ mean (SD) age was 85.7(3.9);
predominantly female (72%); and 87.5% were ‘independent
with daily living’. 72% of augmentation were performed
during an acute presentation (vertebroplasty, 96%). Pre- and
post-procedure VAS was documented in 10/25 cases. Postop, 70% had improved VAS (ranged from -2 to -8); and 20%
had increased VAS scores (ranged from +1 to +3). ODI was
documented in 6/25 cases [mean ODI; pre-op, 51%, post-op,
31% (p=0.05)]. In those admitted acutely, there was a 40%
decrease in number of opioids prescribed on discharge,
with a 58% and 23% decrease in average dose of weak and
strong opioids respectively. Median (IQR) inpatient stay was
12.5(8.5) days with no reported inpatient mortality. There
was no worsening in mobility and only 2/25(8%) had an
increase in their care support.
Conclusions: In this cohort that is susceptible to adverse
effects of opioids, its requirements were significantly
reduced post-augmentation with improvement in pain/
disability indices (where documented). Benefits are seen in
augmentation for osteoporotic VF in ‘older-old’ patients.
(P45)
Cost implications of routine bone biopsy in
percutaneous vertebroplasty/kyphoplasty
Main Author: Majeed Shakokani
Co Authors: Tom Robinson, David Cumming, Robert Lovell,
Shaishav Bhagat, John Powell, Saajid Kaleel
Affiliation: Ipswich Spinal Unit, Ipswich
Conflicts of Interest: No conflict of interest
Funding Sources: No funding obtained
Background Context: The lifetime risk for a wrist, hip or
vertebral compression fracture (VCF) has been estimated to
be between 30% to 40% in developed countries and up to
2 people per 100,000 in England are currently treated with
percutaneous vertebroplasty and percutaneous balloon
kyphoplasty. Bone biopsy is recommended to rule out other
causes of VCF such as malignancy. There is debate about the
necessity of routine biopsy and its cost-effectiveness.
Purpose: To assess the need and costs of a routine bone
biopsy in VCF.
Study Design/Setting: Retrospective study
Patient Sample: Cohort of consecutive patients undergoing
vertebroplasty/kyphoplasty over a 2 year period
Outcome Measures: Primary outcome: Positive results in
the routine biopsies
113
Secondary outcome: Cost of a Bone biopsy
Methods: Patient’s demographics, indication for surgery,
level of augmentation, histopathology results, complications
and outcomes were extracted from electronic records. Cost
of a routine biopsy was calculated based on theatre, surgeon,
consumables and histopathology costs.
Results: 64 patients, 129 levels were augmented, Mean
age of 64, length of stay of 3 days, follow up of 22 weeks,
and mean last point of care was 60 weeks. All underwent
imaging and were discussed in a multi-disciplinary meeting
(MDT). Out of the 64 patients, 22 suspected malignancy
group, 18 patients underwent biopsy. Out of the 42 patients
in whom malignancy was not suspected, routine biopsy
was performed in 17 patients. No malignancies found in
the unsuspected malignancy group vs 5 positive samples
in the suspected group. Routine biopsy did not change the
management plan. Average total cost of a routine biopsy
was between £210 and £310.
Conclusions: Contrary to the previously published reports,
our study shows that there is no specific role for routine
biopsy during vertebroplasty procedure. This is a reflection
of our MRI reporting and MDT approach. Therefore, we
believe selective biopsy is more cost effective and value
added approach in vertebral compression fractures.
(P46)
Closed internal decapitation: a rare injury. Can
anyone survive?
Main Author: Arun Ranganathan
Co Authors: Senthil Muthian, Alexander Montgomery
Affiliation: The Royal London Hospital, Whitechapel,
London E1 1BB
Conflicts of Interest: None
Funding Sources: None
Background Context: Fractures and dislocations of the
cranio-cervical junction represent one-third of all injuries to
the cervical spine. They are usually caused by high-energy
trauma such as traffic accident or fall from a great height. The
mortality rate is high and the diagnosis is often hampered
by the presence of traumatic brain injury.
Purpose: To describe the surgical treatment of a dual
dislocation at the craniocervical junction-a dislocation of
the atlanto-occipital joint as well as the atlanto –axial joint.
Study Design/Setting: We present the case of a 47 year
old lady who fell under a train and was hit on the head and
neck and she sustained a dislocation of the atlanto-occipital
joint as well as the atlanto –axial joint. She was brought to
our casualty with multiple fractures, including left humerus
shaft, left sided multiple ribs and traumatic brain injury.
Patient Sample: Case report
Outcome Measures: Mortality and neurological function
Methods: The diagnosis was promptly made and she
underwent CT and MRI scans and she was subsequently
taken for emergency surgery. She survived because she was
extricated from the scene and intubated in 15 minutes and
was brought in by the helicopter ambulance service as code
red alert and was on the operating table in 45 minutes. She
underwent stabilisation of occiput to C5 using a posterior
approach. Challenges in positioning due to the highly
unstable nature of the injury and difficulties in surgical
technique are described in detail.
BRITSPINE 2016
Poster Presentations
Results: At 2 year follow up she was found to have normal
neurology except grade 3 motor power in the left upper
limb.
Conclusions: This is a rare injury which occurs in high energy
trauma and prompt recognition and surgical treatment can
be life-saving and even preserve neurological function.
(P47)
Cervical spinal cord injury assessment based on the
diffusion tensor imaging
Main Author: Marcin Czyz
Co Authors: Pawel Szewczyk, Wai Yoon, Włodzimierz
Jarmundowicz, Bronek M Boszczyk
Affiliation: Centre for Spinal Studies and Surgery, D Floor,
West Block, Queen’s Medical Centre, Derby Road, Nottingham
NG7 2UH; Department of Neurosurgery Wroclaw Medical
University, Borowska 213, 50-556 Wroclaw, Poland
Conflicts of Interest: None
Funding Sources: None
Background Context: The Diffusion Tensor Imaging (DTI) is
a well-known modality of the MRI describing the integrity
white matter tracts of the neural tissue by mean of fractional
anisotropy (FA) and apparent diffusion coefficient (ADC).
Purpose: To assess the usefulness of DTI in the acute
assessment of patients after cervical tSCI.
Study Design/Setting: Prospective study.
Patient Sample: Five patients after cervical tSCI. Control
group of five healthy volunteers.
Outcome Measures: ASIA score.
Methods: In each case neurological assessment (ASIA
protocol) was followed by the MRI scan accomplished with
DTI of the cervical spine. The FA and ADC were recorded.
Values obtained were compared to results of the control
group. The strength of association between results of DTI
and ASIA score was tested.
Results: The mean FA in the tSCI and control group was
0.48±0.067 and 0.55±0.013 respectively (p=0.10). The FA
correlated negatively with the ASIA motor score (-0.90,
p=0.037) and severity of neurological deficits (ASIA type
A-E) (-0.95, p=0.014). The mean ADC in the tSCI and control
group was 0.90±0.22 and 0.80±0.06 respectively (p=0.28).
The ADC was positively correlated with ASIA motor score
(0.86, p=0.046). Two patients found with ADC higher than
the reference presented significant neurological recovery
during the three months follow-up.
Conclusions: The DTI may be useful in the early assessment
of the cervical tSCI. The FA reflects functional status of the
spinal cord whilst ADC may serve a potential prognosticator.
Further studies based on a wider cohort are warranted.
(P48)
Predictors of mortality following odontoid peg
fractures in the elderly
Main Author: Stefan Bajada
Co Authors: Abi Ved, Abdul Gaffar Dudinwala, Sashin Ahuja
Affiliation: Welsh Centre for Spinal Surgery & Trauma,
University Hospital of Wales, Cardiff
Conflicts of Interest: No conflicts of interest
BRITSPINE 2016
Funding Sources: No funding obtained
Background Context: Odontoid peg fracture mortality
rates as high as 25-30% have been described. The cause of
this is not completely understood.
Purpose: The aim is to examine if easily identifiable variables
present on admission are associated with mortality following
odontoid peg fractures in the elderly.
Study Design/Setting: Retrospective review in acute spinal
unit.
Patient Sample: A consecutive series of 85 patients with
odontoid peg fractures over the age of 65 years were
identified.
Outcome Measures: Phsyiologic measures: Mortality at 30
days and one year.
Methods: Patient data was reviewed including
demographics, past medical history as well as routine
admission serum investigations. Radiological investigations
were used to assess fracture classification and displacement.
Treatment received was reviewed.
Results: The average age was 82.9 years with most patients
suffering a type 2 fracture 80% (68 patients). Neurological
deficit was present in 12.9% (11 patients). The rate of
mortality was 15% (13 patients) at thirty days increasing
to 24% (21 patients) at one year. A low haemoglobin count
and the presence of neurological deficit were independent
predicators of thirty day mortality on binary logistic
regression analysis. Similarly, a low haemoglobin count,
admission from an institution (residential/nursing home),
neurological deficit and type 3 fractures were predictors of
mortality at one year. A low albumin count was found to be
significantly (p=0.002) associated with one year mortality on
univariate analysis.
Conclusions: As previously described odontoid peg
fractures in the elderly are associated with high mortality
rates. We suggest that these predictors of mortality present
on admission can be utilised to identify patients at high risk.
(P49)
Service evaluation of the impact of a specialist
spinal osteoporosis nurse in initiating bone health
assessment in patients admitted to hospital with
osteoporotic vertebral fractures (VF)
Main Auth or: Almira Haseeb
Co Authors: Terence Ong, Opinder Sahota (Department for
Healthcare of Older People, Nottingham University Hospitals
NHS Trust); Nicola Marsh, Nasir Quraishi (Centre for Spinal
Studies and Surgery, Nottingham University Hospitals NHS
Trust)
Affiliation: Queens Medical Centre, Nottingham University
Hospitals NHS Trust, Derby Road, Nottingham NG7 2UH
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Osteoporosis assessment in VFs
admitted to hospital is poor. Untreated VF leads to further
fragility fractures and significant morbidity.
Purpose: To evaluate the impact of a specialist nurse
(appointed Oct 2014) initiating bone health assessment in
patients admitted with VF.
Study Design/Setting: Retrospective analysis of bone
densitometry (DEXA) referrals in a tertiary spinal unit pre114
Poster Presentations
and post-nurse appointment.
Patient Sample: Patient with osteoporotic VFs treated with
vertebral augmentation were selected into two cohorts
[24 patients (pre-nurse in 2013); 25 patients (post-nurse in
2015)].
Outcome Measures: DEXA referrals as a marker of
osteoporosis assessment.
Methods: Electronic hospital record for DEXA request for
patients post-augmentation for VF. Descriptive statistics
and a 2x2 table were used to analyse comparison between
groups.
Results: Patient characteristics between pre- and post-nurse
cohort demonstrated older age in the pre-nurse appointment
group [mean(SD) 77.5(9.3) vs 68.0(11.4),p=0.00]; but fairly similar
characteristics in gender [female: 66.7% vs 80%,p=0.29]; type
of admission [elective: 79.2% vs 68.0%,p=0.38]; and on existing
osteoporosis treatment pre-augmentation, i.e. as a marker of
known osteoporosis diagnosis, [14.3% vs 24%,p=0.48]. The
appointment of the specialist nurse increased referrals for
DEXA by 3-fold [pre-nurse, 26.1% vs post-nurse, 84.0%; p=0.00].
Conclusions: The appointment of a spinal osteoporosis
specialist nurse has increased the number of patients
referred for bone assessment. DEXA scan results allow risk
stratification of those at risk for future fracture and would
benefit from osteoporosis treatment.
(P50)
Does the quantity of cement leak into the disc
during balloon kyphoplasty influence the
progression of degenerative disc disease and the
occurrence of adjacent vertebral fractures? An
imaging study
Main Author: Bakur Jamjoom
Co Authors: Sanjay Patel, Raj Bommireddy, Zdenek Klezl
Affiliation: Department of Trauma and Orthopaedics, Royal
Derby Hospital, Derby
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Balloon kyphoplasty can be
complicated by cement leak into the disc space but its
consequences have not been adequately examined.
Purpose: We aim to establish whether the quantity of
cement leak into the disc space has any influence on the
progression of degeneration of the affected disc and
whether this increases the incidence of adjacent vertebral
fractures.
Study Design/Setting: Images taken during balloon
kyphoplasty between 1/10/2006 to 31/05/2014 at our
hospital were reviewed for cement leaks. The quantity of
the leak was graded as I: minimal/cloud, II: 20%, III: 20-40%
and IV: >40% of the disc space.
Patient Sample: Out of 316 procedures performed, we
identified 32 affected discs in 26 patients.
Outcome Measures: The degenerative changes in the
affected discs were assessed at presentation and follow up
using the Mimura radiographic and Puertas MRI grading
systems.
Methods: We compared low grade (I) to mid/high grade
(II-IV) leaks using a chi squared test. We also reviewed both
115
imaging modalities for adjacent vertebral fractures.
Results: Follow up radiograph and MRI assessments ranged
6-50 (median 18) and 6-48 (median 21) months respectively.
The mid/high grade leaks (II-IV) were associated with
significantly more radiographic score changes (P=0.04295)
than the low (I). This was not the case for the MRI score
changes, with equal numbers in each group. Two adjacent
vertebral fractures were detected in each group.
Conclusions: Our findings suggest that mid/high grade (IIIV) cement leaks cause an increase in the progression of disc
degeneration when assessed by radiographs, but not MRIs.
(P51)
MRI in spinal trauma – economic effects of evidence
based practice re-evaluation
Main Author: Syed Aftab
Co Authors: Omar Musbahi, Onyinye Akpenyi, Murat Faik,
Arun Ranganathan, Alexander Montgomery
Affiliation: Royal London Hospital, Barts Health NHS Trust,
Whitechapel, London E1 4BB
Conflicts of Interest: None
Funding Sources: None
Background Context: In July 2012, a new policy was
brought in on the usage of MRI in spinal trauma at a major
trauma centre following a systematic review of the literature.
This change in policy contributed greatly towards reducing
bed stay, surgical waiting time, cost and potential morbidity
of immobility and longer hospital stays.
Purpose: We aimed to investigate the financial impact this
has had.
Study Design/Setting: Retrospective cohort study
Patient Sample: Patients presenting with spinal fractures
Outcome Measures: Imaging performed and associated
costs.
Methods: All patients presenting to the hospital with a
spinal fracture between January - June 2012 was compared
to those between January - June 2014. Timings and type of
MRI scans were reviewed, as well as associated costs
Results: Jan - June 2012:
Number of patients identified.................................. 181.
Number who had MRI.................................................. 89 (51%)
Average cost of MRI: : : : : £186.
Average cost per night:............................................... £627.39.
Average wait time between request & scan performed: 47 hours.
Average cost to trust for patient requiring MRI:.£1,438.
Total cost:......................................................................... £120,823
Jan - June 2014:
Number of patients identified :................................ 175.
Number who had MRI : .............................................. 26 (15%).
Average cost of MRI scan : ......................................... £148.
Average cost per night: .............................................. £627.39.
Average wait time between request & scan performed: 33 hours.
Average cost to trust for patient requiring MRI:.£1,027.
Total cost: ........................................................................ £26,717
Conclusions: Updating our policies significantly reduced
bed stay, surgical waiting times, and number of patients
requiring MRI. Overall we produced an estimated 78% cost
reduction. Further studies will look at the clinical and cost
effect of any morbidities associated with prolonged bed stay
in this cohort
BRITSPINE 2016
Poster Presentations
(P52)
(P53)
OsseoFix spinal fracture reduction system – A
safe and effective alternative for kyphoplasty in
vertebral compression fractures
Real time evaluation of spinal mechanics using MRI
Main Author: Sujay Dheerendra
Co Authors: Myles Roach, Prokopis Annis, Radu Popa,
Sathya Thambiraj
Affiliation: Royal Liverpool University Hospital, Prescot
Street, Liverpool L7 8XP
Conflicts of Interest: None
Funding Sources: None
Background Context: Vertebral compression fractures
(VCF) are the most common fragility fractures and are a
significant cause of pain, deformity and morbidity. In recent
years expandable titanium mesh cages such as the OsseoFix
Spinal Fracture Reduction System (Alphatec Spine Inc, CA)
have come into use with promising initial results.
Purpose: To determine whether the OsseoFix system is a
safe and effective method of minimally invasive therapy for
both metastatic and osteoporotic VCF.
Study Design/Setting: Prospective case series
Patient Sample: 18 patients with 52 fractures
Outcome Measures: Visual analogue scale (VAS), Oswestry
Disability Index (ODI), length of inpatient stay and
complications.
Methods: The data was collected prospectively for
patients undergoing treatment with OsseoFix system
from November 2014 to September 2015. The clinical
outcomes were measured using visual analogue scale (VAS),
Oswestry Disability Index (ODI), length of inpatient stay and
complications.
Results: There were 18 patients (M:F = 4:14) with an average
age of 68.5. 52 levels were augmented with OsseoFix system
(38 thoracic and 14 lumbar) between T4 – L5. 11 fractures
were secondary to osteoporotic and the remaining were
secondary to a metastatic deposit. The mean length of
follow up was 3 months (1 – 10 months). All patients are
still under regular follow up. The median length of inpatient
stay was 1 day. There was significant improvement in the
ODI (76.5% to 28.2%) & VAS (8.8 to 1.6) scores at 6 weeks &
continued to be the case at 3 & 6 month follow up. There
were no complications. One patient died due to progression
of metastatic disease.
Conclusions: Stabilisation of VCF with OsseoFix system is
associated with short inpatient stay and low complications
rate with significant improvements in the ODI & VAS
scores. Initial results for minimally invasive therapy of VCF
with OsseoFix system reveal that it is a safe and effective
alternative.
BRITSPINE 2016
Main Author: Alan Parish
Co Authors: Penny Gowland and Donal McNally
Affiliation: University of Nottingham, University Park,
Nottingham NG7 2RD
Conflicts of Interest: None
Funding Sources: Institutional
Background Context: Currently, the only method of
imaging spinal deformations in real time is to use video
fluoscopy which is unable to visualise soft tissues. MRI
imaging of the spine under load is restricted to low field open
scanners which have image acquisition times of the order
biomechanical viscoelastic time constants of intervertebral
discs.
Purpose: To validate the use of an MRI compatible cyclic
loading device synchronised with gated video MRI.
Study Design/Setting: Pilot validation study.
Patient Sample: Adult male with healed burst fracture at L4.
Outcome Measures: Axial compression, A/P shear and
flexion/extension angle at each disc space.
Methods: The subject was loaded cyclically at 40% body
weight using an MRI compatible loading device at 0.25Hz.
Video sagittal plane 3T MRI data sets, synchronised to the
loading device, were captured at 16 time-points. Frame to
frame motion of each vertebra was calculated using image
correlation.
Results: Axial compression and A/P shear of each disc
space was measured with a resolution of 66 microns (0.2
of a pixel via interpolation) and 0.2 degrees. Motion of the
deformed disc spaces adjacted to the healed fracture was
not remarkable.
Conclusions: This study demonstrates the utility of using
video MRI of dynamically loaded spine in vivo using a
conventional high field clinical imager.
(P54)
Paediatric spinal cord injury remote from the site of
musculoskeletal injury: a report of two cases
Main Author: Roozbeh Shafafy
Co Authors: Giuseppe Lambros Morassi, James Hunter,
Masood Shafafy
Affiliation: Centre for Spinal Studies and Surgery, Queens
Medical Centre, Derby Road, Nottingham NG7 2GY
Conflicts of Interest: None
Funding Sources: None
Background Context: Paediatric spinal cord injuries in
the presence of high-energy trauma are well documented.
These are often associated with musculoskeletal injuries in
proximity to the site of spinal cord lesion.
Purpose: We report two cases of spinal cord injury where
the cord lesions were not in proximity to the recognized
musculoskeletal injuries.
Study Design/Setting: A retrospective review of two cases
Patient Sample: Two siblings aged 6 and 8 years of age
were backseat passengers involved in a high-speed road
116
Poster Presentations
traffic accident whilst wearing lap seatbelts.
Outcome Measures: n/a:
Methods: The younger patient presented with a complete
cord lesion at the level of T7 associated with a L1/2 fracture
dislocation. The patient underwent urgent decompression
and stabilisation with posterior instrumentation and fusion.
The older patient presented with a complete cord lesion at
T12 and bilateral iliac wing fractures, which were treated
conservatively.
Results: At 8 weeks neither patient showed any signs of
neurological recovery. We postulate the mechanism of cord
injury in both patients was flexion-distraction of the spine.
Whilst both patients have been restrained by lap belts the
trunk was thrown forward leading to elongation of the
vertebral column whilst the spinal cord has remained fixed.
Conclusions: Spinal cord injury remote from the site of
musculoskeletal injury is a rare phenomenon. We have
observed two such cases in our practice and speculate
these have been due to distraction of the cord. Clinicians
must be aware that spinal cord injury may occur away
from recognised musculoskeletal injuries in the paediatric
population. Upper body restraint may have prevented these
cord injuries.
Spinal Tumour
(P55)
Systematic review of sacroplasty for metastases to
the sacrum
Main Author: Katie Siggens
Co Authors: Silviu Sabou, Dritan Pasku, Nasir A Quraishi
Affiliation: Centre for Spinal Studies and Surgery, Queens
Medical Centre Campus of Nottingham University Hospitals
NHS Trust, Derby Road, Nottingham, NG7 2UH
Conflicts of Interest: no conflicts of interest
Funding Sources: no funding obtained
Background Context: There is limited literature on the
treatment of sacral metastasis.
Purpose: The aim of this paper was to perform a critical
review of the available literature looking at the clinical
outcomes of sacroplasty in the management of secondary
sacral metastases.
Study Design/Setting: Structured review and analysis of
the literature.
Patient Sample: Our literature search identified 9 studies
(all level 4) with a total of 172 patients.
Outcome Measures: Length of follow up, pre and
postoperative VAS, complication rate.
Methods: We conducted an electronic search of the
Medline database using the Pubmed search engine and also
the Cochrane Library entering the search term “sacroplasty”
or “vertebroplasty OR kyphoplasty AND sacrum”. We limited
our results to articles published in the English language
that reported on at least 3 cases of sacroplasty for sacral
metastasis.
Results: In our study group, the average follow up was
6 months (range 2 weeks -12 months). The most frequent
primary tumour was breast (n=42, 29%), followed by
117
multiple myeloma (n=30, 20.4%) and lung (n=12, 8%).The
mean preoperative VAS was 8.43 (range 5.3-10), and the
mean postoperative VAS was 2.8 (range 0.72-4.5). The only
complication reported was cement leakage which occurred
in 9 patients; however this was clinically relevant in only 3
patients (3/172 , 1.7%).
Conclusions: Sacroplasty in the management of sacral
metastases is a safe and effective procedure. Our literature
review found consistent and significant reduction in pain as
quantified by VAS scores with a low complication rate (<2%).
(P56)
The accuracy of prognostic scoring systems in
predicting survival of lung cancer patients with
spinal metastases
Main Author: Naresh Kumar1
Co Authors: Jonathan Tan1, Kimberly Anne Tan1, Aye Sandar
Zaw1, Gabriel Tan1, Naresh Kumar1, Aravind Kumar2
Affiliation: 1.Department of Orthopaedic Surgery, National
University Health System, Singapore, 2.Department of
Orthopaedic Surgery, Khoo Teck Puat, Singapore
Conflicts of Interest: None
Funding Sources: None
Background Context: The modified Tokuhashi, Tomita,
modified Bauer and Oswestry scores are currently used to
guide decisions regarding operative treatment of patients
with spinal metastases. The best system for predicting
survival in patients with lung cancer spinal metastases
remains undetermined.
Purpose: To evaluate these scoring systems in patients with
spinal metastases from lung cancer
Study Design/Setting: Retrospective analysis
Patient Sample: 180 patients with lung cancer spinal
metastases treated at our institution between May 2001 and
August 2012 were studied.
Outcome Measures: The primary outcome measure was
survival from the time of diagnosis.
Methods: Scoring-predicted survival was compared with
actual survival. Potential prognostic factors were investigated
using Cox regression analyses. Predictive values of each
scoring system for 3 and 6-month survival were measured via
receiver operating characteristic (ROC) curves.
Results: 51 patients were treated surgically. Histological
subtype (p=0.015), gender (p=0.001), Karnofsky
performance scale (p=0.001), extent of neurological palsy
(p=0.002) and visceral metastases (p=0.037) are significant
predictors of survival. Besides the Oswestry spinal risk index,
no significant differences were found between different
prognostic subgroups within the individual scoring systems.
Although the modified Bauer score was most accurate, all 4
scoring systems had areas under the ROC curve ≤0.5.
Conclusions: Although better prognostic scores
correlated with longer survival, all four scoring systems are
inaccurate in prognosticating patients with lung cancer
spinal metastases. Specific lung cancer histology appears
prognostic and should be given consideration especially
given the increased survival of patients receiving new
targeted therapies appropriate to their disease.
BRITSPINE 2016
Poster Presentations
(P57)
(P58)
Blood loss in spinal tumour surgery: evaluation of
influencing factors
The influence of histological subtype in predicting
survival of lung cancer patients with spinal
metastases
Main Author: Naresh Kumar1
Co Authors: Aye Sandar Zaw1, Hnin Ei Khine1, Barry Tan1,
Khin Lay Wai1, Karthikeyan Maharajan1, Aravind Kumar2
Affiliation: 1.Department of Orthopaedic Surgery, National
University Health System, Singapore, 2.Department of
Orthopaedic Surgery, Khoo Teck Puat, Singapore
Conflicts of Interest: None
Funding Sources: None
Background Context: Spinal tumour surgery (STS) can
be associated with significant blood loss. Previous studies
did not provide comprehensive data on blood loss in STS.
Thorough study elaborating blood loss and their influencing
factors is required.
Purpose: To investigate the estimated blood loss associated
with various surgical approaches and operated vertebral
levels for different types of spinal tumours
Study Design/Setting: Retrospective analysis
Patient Sample: We evaluated 255 patients who underwent
surgery for primary or metastatic spine tumours in our
institution during 2005-2014.
Outcome Measures: Blood loss
Methods: Estimated intraoperative blood loss was
assessed for different types of primary tumour (I: highly
vascularised, II: moderately vascularised, III: hematological
and IV: primary bone tumour); types of surgical procedure
(cervical
corpectomy±stabilization;
thoracolumbar
posterior decompression±instrumentation; thoracolumbar
corpectomy; minimally invasive surgery), levels of
instrumentation and decompression. Multivariate linear
regression was attempted to investigate the factors
influencing blood loss.
Results: Mean blood loss was 660 ml (range: 20-6000ml).
Multivariate analysis revealed that intraoperative blood
loss rose significantly in proportion to increasing levels of
decompression as well as instrumentation. Compared to
highly vascularised tumour group, there was a significant
reduction in mean blood loss in moderately vascularised
and haematological tumour groups (-617 ml and -436 ml
respectively). Compared to open cervical approach, there
was a significant reduction in mean blood loss in minimally
invasive surgery (-614ml) and a borderline increase in
thoracolumbar corpectomy surgery (319 ml).
Conclusions: There were significant variations in blood
loss based on primary tumours, surgical approaches and
operative time. This will help us in implementing more
effective blood conservation strategies during STS.
BRITSPINE 2016
Main Author: Naresh Kumar1
Co Authors: Kimberly Anne Tan1, Jonathan Tan1, Aye Sandar
Zaw1, Aravind Kumar2
Affiliation: 1.Department of Orthopaedic Surgery, National
University Health System, Singapore, 2.Department of
Orthopaedic Surgery, Khoo Teck Puat, Singapore
Conflicts of Interest: None
Funding Sources: None
Background Context: Recent advancements in systemic
therapies for lung cancer have significantly improved the
survival of patients with certain histological subtypes. Since
existing prognostic scoring systems do not consider the
histological sub-type, they have little to no prognostic value
in lung cancer spinal metastases.
Purpose: To analyse survival of lung cancer patients
with spinal metastases according to different histological
subtypes
Study Design/Setting: Retrospective analysis
Patient Sample: 180 patients with lung cancer spinal
metastases treated at our institution between May 2001 and
August 2012 were studied.
Outcome Measures: Survival from the time of diagnosis
Methods: Patient demographic variables, lung cancer
histology and various modalities of oncologic treatment
were evaluated. Univariate and multivariate cox regression
analyses were performed.
Results: The overall median survival time was 4.8 months,
(0.1-111.1). When subdivided according to histology,
patients with non-small cell lung cancer (NSCLC) had a
median survival of 5.2 (0.1-111.1) months while patients
with small cell lung cancer had a median survival of 2.4
(0.1-11.9) months. Female gender (p=0.049), Chinese
ethnicity (p=0.040), NSCLC (p<0.001), epidermal growth
factor receptor tyrosine kinase inhibitor (EGFR TKI) therapy
(p<0.001), platinum doublet chemotherapy (p<0.001) and
local radiotherapy (p=0.070) for spinal metastases were all
significant good prognostic factors.
Conclusions: Female gender, Chinese ethnicity, NSCLC,
EGFR TKI therapy, platinum doublet chemotherapy, and
local radiotherapy for spinal metastases are all independent
favourable prognostic factors for patients with lung cancers
and spinal metastases. Profiling patients according to these
factors should help guide decisions for surgical management
of spinal metastases given that prognostic scoring systems
are currently not predictive in this patient group.
118
Poster Presentations
(P59)
Versatility of percutaneous pedicular screw fixation
in metastatic spine tumour surgery
Main Author: Naresh Kumar1
Co Authors: Aye Sandar Zaw1, Rishi Malhotra1, Pang Hung
Wu1, Milindu Makandura1, Aravind Kumar2
Affiliation: 1.Department of Orthopaedic Surgery, National
University Health System, Singapore, 2.Department of
Orthopaedic Surgery, Khoo Teck Puat, Singapore
Conflicts of Interest: None
Funding Sources: None
Background Context: Minimally invasive surgery has
evolved to address the problems associated with metastatic
spine diseases (MSD).
Purpose: To evaluate the feasibility and spectrum of
application of Posterior percutaneous spinal fixation (PPSF)
in management of MSD, highlighting its clinical advantages
Study Design/Setting: Prospective analysis
Patient Sample: Twenty-seven patients with MSD treated
with PPSF in our institution from January 2011 to June 2014
were studied.
Outcome Measures: Pain, Ambulation, Frankel score, blood
loss, operative time, hospital stay
Methods: The analysis was stratified by 4 groups of PPSF.
Demographic data, operative details, and clinical outcomes
were investigated for each category and compared pre and
postoperatively.
Results: There was significant difference between preoperative
and postoperative mean VAS score in all groups except group
4. Significant difference between pre and postoperative ECOG
score was seen in group 2. Frankel score E was achieved postoperation in 88% of patients in PPSF group 1, 89% in group 2,
71% in group 3 and 50% in group 4. The differences in these
scores between pre and post-operation, however, did not
reach statistically significant level. Independent ambulation
was achieved in 100% in PPSF group 1, 80% in group 2, 84%
in group 3, 50% in group 4. Stabilization group had the lowest
amount of mean blood loss, shortest operative time, ICU and
hospital stays in contrast to the long construct group.
Conclusions: PPSF is a safe surgical modality in patients
with poor prognostic scores and with spinal instability, while
reducing surgical morbidity. It improves functional outcome
and quality of life in these patients.
(P60)
Outcome of surgical management of spinal
metastases secondary to renal cell carcinoma in a
district general hospital
Main Author: James N Hadfield
Co Authors: A-M Hill, L Jagonase, S England, A T Cross, G S
Roysam, P Lakshmanan
Affiliation: Sunderland Royal Hospital
Conflicts of Interest: no conflicts of interest
Funding Sources: no funding obtained
Background Context: Metastatic spread of Renal Cell Carcinoma
(RCC) to the spine is common; symptoms include pain and/or
neurological deficit. Surgical intervention offers symptomatic
119
relief using a combination of tumour de-bulking, vertebral
stabilisation and spinal cord decompression. A Tokuhashi scoring
system predicts prognosis and guides management decisions. In
isolated RCC spinal metastasis, surgical cure can be attempted.
Purpose: To investigate patient survival time following
surgical management of spinal metastases secondary to RCC.
Study Design/Setting: Retrospective study of prospectively
collected data in a District General Hospital (DGH).
Patient Sample: Patients with spinal metastases secondary
to RCC operated on at a DGH with MDT facilities and preoperative embolisation techniques available within the last
five years.
Outcome Measures: Survival time and recurrence of spinal
metastases.
Methods: Eighteen patients met the selection criteria.
A Tokuhashi score and post-operative survival time was
calculated and survival data used to formulate a KaplanMeier graph. The graph was used to estimate survival time in
patients with symptomatic RCC spinal metastases following
surgical intervention.
Results: Survival time following surgery ranges from 241426 days; average 604 days. There is a weak correlation
between Tokuhashi score and survival time. The KaplanMeier graph demonstrates a biphasic distribution of survival
time with peak death rates around 100 and 1100 days. The
second peak of death rate at the 3-year mark is from further
metastasis to other organs, especially the brain.
Conclusions: The Tokuhashi scoring system is an unreliable
prognostic indicator and can be overlooked when deciding
upon surgical management. Increase in mortality is often
from spread of RCC metastasis to other organs, especially
the brain.
(P61)
Orthopaedic trainee knowledge of the guidelines for
the treatment of malignant spinal cord compression
Main Author: Mark Harris
Co Authors: Jaykar Panchmatia
Affiliation: Guys and St Thomas’ NHS Foundation Trust
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Malignant spinal cord compression
(MSCC) causes significant morbidity for patients with cancer.
The National Institute of Clinical Excellence (NICE) guidelines
for the management of MSCC highlights the need for early
suspicion, diagnosis and treatment to improve outcomes.
Purpose: We surveyed 32 orthopaedic trainees (ST3 to ST8)
at the start of their regional spinal term teaching. The aim
was to assess the level of knowledge of the management of
MSCC and the NICE guidelines
Study Design/Setting: Survey of orthopaedic trainees
Patient Sample: 32 south Thames trainees
Outcome Measures: Questionnaire
Methods: We asked 32 trainees 11 questions relating to the
NICE guidelines for the management of MSCC.
Results: 26(81%) of the trainees stated they were aware of
the guidelines for MSCC however only 15(47%) correctly
identified NICE. The recommended maximum wait for
imaging and referral on to an MSCC coordinator, timing of
BRITSPINE 2016
Poster Presentations
radiotherapy, and the use of steroids were all poorly known.
Conclusions: The knowledge of the guidelines for the effective
management of MSCC amongst orthopaedic trainees is poor
and needs to be addressed in local and regional teaching.
(P62)
Primary intradural soft tissue sarcoma of the spine –
a decade’s experience
Main Author: Timothy Hammett
Co Authors: Ashwin Kumaria, Laurence Glancz, Maria
Cartmill, Richard Ashpole, Barrie White
Affiliation: Department of Neurosurgery, Nottingham
University Hospitals
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding sought or obtained.
Background Context: Primary sarcoma of the osseous spine
is rare, and primary extra-osseous sarcoma of the spine is
rarer still. We present five cases from our institution between
2005-2015 and discuss their presentation, surgical and
oncological treatment, histology and subsequent prognosis.
Purpose: To add to the sparse literature regarding intradural
sarcoma of the spine.
Study Design/Setting: A retrospective study of five
patients with histologically confirmed diagnoses of primary
intradural sarcoma.
Patient Sample: All patients with histologically confirmed
primary intradural sarcoma from 2005-2015 at a tertiary
centre.
Outcome Measures: Neurological function and survival.
Methods: Retrospective notes review.
Results: Five patients underwent surgical management
of their primary soft tissue sarcoma during the period in
question. 2 were confirmed as Ewing’s Sarcoma and 2 as
malignant peripheral nerve sheath tumours, with a final
‘indeterminate small blue cell’ sarcoma. All five were Frankel
D pre operatively, with no deterioration immediately post
operatively. Two required further procedures. Survival varied
from 5-31 months, with one patient alive at submission.
Conclusions: These rare tumours cause diagnostic
problems clinically, radiologically and histologically. Surgical
debridement, supplementary radiotherapy, and appropriate
chemotherapy remain the mainstay of treatment. Outcomes
appear worse for intradural sarcoma than for peripheral
tumours of similar type.
(P63)
Percutaneous radiofrequency ablation of spinal
osteoid osteoma under CT guidance
Main Author: Giuseppe Lambros Morassi
Co Authors: Konstantinos Kokkinis, Orestis Karargyris,
Spyros Koufos, Dimitrios S Evangelopoulos, Spyros G
Pneumaticos
Affiliation: The Center for Spinal Studies and Surgery,
Nottingham; 3rd Department of Orthopaedic Surgery, KAT
Hospital, University of Athens, Athens, Greece
Conflicts of Interest: Nil
Funding Sources: Nil
BRITSPINE 2016
Background Context: Osteoid osteoma accounts for
approximately 10 to 12% of all benign bone tumors and 3%
of all bone tumors. Spinal involvement appears in 10 to 25%
of all cases.
Purpose: The purpose of this study was to evaluate the
safety and efficacy of CT-guided radiofrequency ablation
in the treatment of spinal osteoid osteomas and report our
experience.
Study Design/Setting: Retrospective study
Patient Sample: Thirteen patients suffering of spinal
osteoid osteoma and treated using radiofrequency ablation
under CT- guidance were retrospectively evaluated.
Outcome Measures: All patients were submitted to
neurological examination and evaluation of their pain prior
to the procedure and during follow up. Pain was evaluated
using the visual analogue scale (VAS).
Methods: Thirteen patients were treated using
radiofrequency ablation under CT- guidance. All procedures
were performed under general anaesthesia. After location of
the nidus a core biopsy of the lesion was performed prior
to ablation. A radiofrequency probe was inserted through a
biopsy needle and lesion was heated at 900C for 6 minutes.
Results: Eleven out of thirteen patients reported pain relief
after RF ablation. In two cases, RF ablation was repeated one
month after the first procedure. Pain relief was achieved in
both cases after the second procedure. No recurrence was
reported throughout the follow- up. No complications like
skin burn, soft tissue haematoma, infection, vessel damage
or neurological deficit were reported. Conclusions: The current study demonstrates that CT
guided percutaneous RF ablation is a safe and effective
method for the treatment of spinal located osteoid osteomas
with excellent mean-time results. In our opinion CT guided
percutaneous RF ablation is the treatment of choice for the
management of spinal osteoid osteoma.
(P64)
Management of metastatic spinal cord compression
(MSCC) in a university teaching hospital
Main Author: Sujay Dheerendra
Co Authors: Richard Bailey, Sophie Dodd, Mark McGowan,
Radu Popa, Prokopis Annis, Sathya Thambiraj, Antonino
Russo, Marcus de Matas
Affiliation: Royal Liverpool University Hospital, Prescot
Street, Liverpool L7 8XP
Conflicts of Interest: None
Funding Sources: None
Background Context: A previous audit in Scotland had
shown that there were significant delays, in their practice,
prior to patients being suspected to have metastatic spinal
cord compression (MSCC) either in the community or in
the hospital, resulting in very few patients qualifying for a
surgical intervention. National Institute for Health & Clinical
Excellence (NICE) has developed a guideline in managing
patients with suspected MSCC emphasizing on early
diagnosis and definitive management.
Purpose: The aim of this study is to prospectively evaluate
the management of patients presenting with MSCC to a
university teaching hospital.
Study Design/Setting: Retrospective case series
120
Poster Presentations
Patient Sample: 131 patients with MSCC
Outcome Measures: Frankel, Barthel, VAS & Karnofsky scores
and Tokuhashi staging, pre-treatment with reassessment on
discharge & at follow up.
Methods: The data was collected, between September
2010 and August 2015, prospectively by the MSCC coordinator. The data included patient demographics, Frankel,
Barthel, VAS & Karnofsky scores and Tokuhashi staging, pretreatment with reassessment on discharge & at follow up.
Results: There were 131 patients with MSCC with an average
age of 69. The patients were divided into surgical group (SG)
(n=52) and radiotherapy group (RG) (n=67) groups. The
remaining patients (n=13) were managed palliatively. The
median Tokuhashi score for surgery was 8 and radiotherapy
was 7, demonstrating a significant difference (p<0.05).
The VAS and Karnofsky scores were significantly better on
discharge in SG and did not change at follow-up. Median
survival of patients in SG was 180 days and 64 days for
patients in RG. The median time to obtain a MRI scan from
the time of referral was 18.24 hours.
Conclusions: Spinal surgery for MSCC clearly provides
improvement in quality of life. The surgical selection process
is crucial but complex and needs clear understanding of the
whole pathological process from the surgical team making
the decision.
(P65)
Hybrid minimal invasive technique for
decompression and stabilization at the thoracolumbar spine – early results
Main Author: A M Rafique
Co Authors: C H Lee, A T H Casey, V M Russo
Affiliation: National Hospital for Neurology and
Neurosurgery, London
Conflicts of Interest: No conflicts of interest
Funding Sources: No funding obtained
Background Context: Minimally invasive techniques
are increasingly utilized for spine stabilization and
decompression, aiming to decrease intra and perioperative
morbidity associated with traditional open spine surgery.
Indication for open surgery is often limited in patients with
numerous comorbidities and/or limited life expectancy such
as spinal metastasis.
Purpose: To evaluate safety and efficacy of hybrid minimal
Invasive (HMI) decompression and stabilization at the
thoraco-lumbar spine.
Study Design/Setting: Prospective study
Patient Sample: 12 consecutive patients treated at single
institution.
Outcome Measures: ASIA, VAS, EORTC (QLQ-C30 and QLQBM22).
Methods: Patients with acute spinal cord compression, who
underwent HMI procedures were prospectively enrolled
(Sept 2014-15). Results analyzed included neurological
recovery (ASIA), complications, pain (VAS), and Quality of
life EORTC (QLQ-C30 and BM22) scales at 6-months followup. Operation time, intraoperative blood loss, postoperative
bed-rest and hospitalization were also evaluated.
Results: Mean age of cohort was 61 years (48 – 80years).
Surgical indications included spinal metastasis (9), trauma
121
(1) and infection (2). Mean operative time was 214 minutes.
Mean Intraoperative blood loss was 208mls; with one case
requiring blood transfusion due to patient haematological
background. Median postoperative bed rest duration was 2
days with one patient remaining paraplegic pre and postoperatively (ASIA B). Other ASIA scores remained E. Mean
VAS improved from 9 pre-operatively to 3.4 post-operatively.
QLQ-C30 and BM22 scores showed improvement from 93/91
(pre-operative) to 33/32 (post-operative) respectively.
Conclusions: HMI technique is safe and effective for spinal
cord decompression and spinal stabilization, reducing the
impact of surgery in critical patients and recovery time. This
is often crucial for patients with spinal metastasis requiring
further lines of treatments.
(P66)
Minimally invasive percutaneous pedicle screw
stabilisation surgery for spinal metastasis –
outcome and survival analysis
Main Author: Ali Raza
Co Authors: J N Hadfield, A M Hill, L Jagonase, A T Cross, G
Roysam, P Lakshmanan
Affiliation: Sunderland Royal Hospital, Kayll Rd, Sunderland,
Tyne and Wear SR4 7TP
Conflicts of Interest: no conflicts of interest
Funding Sources: no funding obtained
Background Context: Minimally invasive surgery (MIS)
has revolutionised the care of spine patients with early
recovery and better outcome even in patients with multiple
comorbidities. Its use in patients with metastatic spine
disease is associated with reduced surgical morbidity and
plays a vital role in their management.
Purpose: We aim to review the patient demographics,
extent of surgery, complications and survival analysis of
patients undergoing minimally invasive spine surgery for
spinal metastasis.
Study Design/Setting: Case series of prospectively
collected data in a District General Hospital (DGH).
Patient Sample: Patients with spinal metastases treated
with MIS in DGH over last 3 years.
Outcome Measures: Descriptive statistics, survival analysis
and operative complications.
Methods: 26 patients underwent MIS for thoracic/lumbar
spine metastases. We analysed the patient demographics,
extent of surgery, and operative complications. KaplanMeier curve was constructed for survival analysis.
Results: Mean age of patients was 66 years (48-85 years) with
male to female ratio (2.2:1). 24% patients had CA lung, with
prostate and renal cell carcinoma representing 20% each.
The highest level of surgery was performed at T3 and the
lowest was at S1. The number of spinal segments stabilised
was median 6 (range 2-8). There was 1 patient with wound
infection and 1 who developed atrial fibrillation post op.
Kaplan-Meier curve showed 45% survival by 1 year falling
to 30% over 2.5 years post op. None of them had metalwork
failure.
Conclusions: Our study shows that minimally invasive
surgery is a safe procedure with reduced morbidity and
helps maintain quality of life with approximately one third
of patients surviving beyond 2.5 years post-surgery.
BRITSPINE 2016
Poster Presentations
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Posters and Exhibition Floor Plan
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BRITSPINE 2016
Exhibitors’ Profiles
BritSpine 2016 gratefully acknowledges the generous contribution that the sponsors have made to make this event possible.
Gold Sponsors
DePuy Synthes Companies of Johnson and Johnson is the
largest, most innovative and comprehensive orthopaedic
and neurological business in the world. DePuy Synthes Spine
offers a comprehensive portfolio of spinal care solutions for
the treatment of the most simple to the most complex spine
disorders using traditional and minimally invasive techniques.
K2M Group Holdings, Inc is a global medical device company
focused on designing, developing and commercialising
innovative complex spine and minimally invasive spine
technologies and techniques used by spine surgeons to treat
some of the most difficult and challenging spinal pathologies.
K2M has leveraged these core competencies to bring to market
an increasing number of products for patients suffering from
degenerative spinal conditions. These technologies and
techniques, in combination with a robust product pipeline,
enables the company to favourably compete in the global
spinal surgery market.
NuVasive is a medical device company focused on developing
minimally disruptive surgical products and procedures for the
spine. The company’s principal product offering is based on
the Maximum Access Surgery (MAS) platform which delivers
the benefits of minimally invasive surgery while providing
maximum surgical access. NuVasive offers more than 90
products spanning lumbar, thoracic and cervical applications.
Stryker is one of the world’s leading medical technology
companies and, together with our customers, we are driven
to make healthcare better. The company offers a diverse array
of innovative medical technologies, including reconstructive,
medical and surgical and neurotechnology and spine products
to help lead more active and more satisfying lives. Stryker
products and services are available in over 100 countries.
BRITSPINE 2016
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Exhibitors’ Profiles
Silver Sponsors
Alphatec Spine is a global provider of spinal fusion technologies
for the treatment of spinal disorders associated with trauma,
congenital deformities, disease and degeneration. The
company’s mission is to combine innovative surgical solutions
with world-class customer service to improve outcomes and
patient quality of life.
As a global leader in medical technology, services and solutions,
Medtronic improves the lives and health of millions of people
each year. We use our deep clinical, therapeutic and economic
expertise to address the complex challenges faced by healthcare
systems today. Let’s take healthcare Further, Together. Learn
more at Medtronic.com.
Bronze Sponsors
Globus Medical, Inc is a leading musculoskeletal implant
manufacturer and is driving significant technological
advancements across a complete suite of spinal products.
Founded in 2003, Globus’ single-minded focus on advancing
spinal surgery has made it the fastest growing company in the
history of orthopaedics.
Silony Medical develops and produces implant and instrument
systems that are precisely tailored to the needs of patients,
doctors and hospital staff. We believe a product should adapt to
the user and not the other way around. We wish our customers
to consider us as a partner not just a supplier. As such, we
develop all of our products jointly with clinicians to ensure they
are as practical as possible. We co-operate closely with some
of Europe’s most experienced surgeons who contribute not
only their requests and requirements, but also offer valuable
suggestions to help us realise and improve our systems and
services. We believe that service is only worthy of the name
if it remains flexible and transparent. We work together to
find intelligent solutions to existing problems, guard against
future obstacles and optimise proven solutions down to the
highest standard. Everyone at Silony is highly motivated and
committed to delivering change in our industry. We all subscribe
to a set of core values: commitment, integrity, teamwork and
uncompromising quality.
Working Together, Changing Lives
At Zimmer Biomet, our knowledge and our expertise help
healthcare professionals deliver the highest patient outcomes.
Our hard work and collaboration with our customers and with
each other drives innovation, service and results. We know that
our work changes human lives, that what we make becomes
a part of a person and helps her or him live with less pain and
greater freedom. Simply put, we are in the business of changing
lives so our actions and behaviours are guided by our Purpose,
Mission and Values.
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Other sponsors
GTA will be showcasing their innovative and patented Herniatome percutaneous discectomy device which
offers a safe and minimally invasive alternative for decompression of herniated discs. Alchemy present
the complete bone regeneration product range from Curasan: CERASORB® pure-phase ß-TCP mouldable
collagen/TCP foam, strips, paste, granules and blocks.
Anchor Orthopedics is a medical device company developing innovative solutions for spine surgery. Our
mission is to provide spine surgeons with easy to use devices designed to address specific clinical needs.
We work closely with surgeons to create clinical solutions which improve the lives of patients around the
world.
AOSpine is an international community of spine surgeons generating, distributing and exchanging
knowledge to advance science and the spine care profession through research, education and community
development. AOSpine develops consistent and practical educational programs, strategies and tools for
implementation in educational events worldwide, covering all pathologies and the different stages in a
surgeon’s career.
The ApiFix system is indicated for Adolescent Idiopathic Scoliosis patients with deformity classified as
Lenke type 1 and 5 and a Cobb angle from 40 to 60 degrees. The procedure is a short and comparatively
minimal, simple one in which an “internal brace” is implanted. The small implant is attached to the spine
at the apex of the major curve using only two screws. It takes about one hour and upon completion, the
patient returns home after a short hospitalisation period (2-3 days) with a physical therapy regimen to
activate the implant.
Aesculap Spine offer a broad portfolio of products shaped by a single philosophy: offer high-quality
products that help surgeons improve the quality of a patient’s life. From advancements in total lumbar disc
replacement with activL® and the surface enhancing technology of Plasmapore®XP to innovative cervical
plating systems and instrumentation.
BackCare aims to significantly reduce the burden of back pain by providing information and advice
to all people and organisations affected by back pain. We fund scientific research into the causes,
prevention and management of back pain. Back pain is a major health issue, costing the country and the
health service billions of pounds every year. Sickness absence currently costs the UK economy £15bn musculoskeletal disorders are one of the leading causes of sickness absence. We believe that by working
together with other organisations, we can help prevent back and neck pain which has a significant impact
on more than 80% of the UK population.
Baxter International Inc provides a broad portfolio of essential renal and hospital products including
home, acute and in-centre dialysis; sterile IV solutions; infusion systems and devices; parenteral nutrition;
biosurgery products and anaesthetics; and pharmacy automation, software and services. The company’s
global footprint and the critical nature of its products and services play a key role in expanding access
to healthcare in emerging and developed countries. Baxter’s 50,000 employees worldwide are building
upon the company’s rich heritage of medical breakthroughs to advance the next generation of healthcare
innovations that enable patient care.
The British Orthopaedic Association (BOA) is the surgical specialty association for trauma and orthopaedics
in the UK focusing on excellence in professional practice, training and education and research. Founded
in 1918 we now have over 4,300 members, supporting Consultants, Staff and Associate Specialist grades
(SAS) and Trainees.
Brainlab, headquartered in Munich, develops, manufactures and markets software-driven medical
technology, enabling access to advanced, less invasive patient treatments. Core products center on
information-guided surgery, radiosurgery, precision radiation therapy, digital operating room integration,
and information and knowledge exchange. Brainlab technology powers treatments in radiosurgery and
radiotherapy as well as numerous surgical fields including neurosurgery, orthopedic, ENT, CMF, spine
and trauma. Privately held since its formation in Munich, Germany in 1989, Brainlab has more than 9,000
systems installed in about 100 countries. Brainlab employs 1,300 people in 19 offices worldwide, including
320 Research & Development engineers, who form a crucial part of the product development team.
Spinal Surgery can change a person’s life. Many different operations are available for a host of spinal
problems. Thousands of spinal operations are performed every year in the UK. The British Spine Registry
(BSR) was set up by the British Association of Spine Surgeons (BASS) to monitor the outcomes of spinal
procedures.
The British Scoliosis Research Foundation (BSRF) is the only charity that exists solely to promote research
into the treatment of scoliosis in the UK. The BSRF funds a great deal of research into scoliosis and holds
the biennial Zorab Symposium to share knowledge gained from the latest research.
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Other sponsors
We are the UK’S first and only registered charity for Cauda Equina Syndrome (CES) and we are committed
to raising awareness of this often debilitating condition which can affect anyone, at any time, regardless of
age, gender or fitness level. The charity was founded in October 2011 by Annie Glover, a sufferer of CES for
3 years.
Cavernoma Alliance UK (CAUK) is a small national charity founded in 2005 in Dorchester by Dr Ian Stuart.
We are unique, being the only organisation in Britain dedicated to assisting those with cavernoma and
provide vital advice, information and support. CAUK complements the National Health Service providing
cavernoma-specific information booklets, support groups, family support meetings, a website, social
media forums and a telephone support line.
Edge Medical is a leading medical device company focused on offering the best in class and most
technically advanced products within each of our divisions. Edge Medical was founded in 2011 by a team
of industry specialists focused on delivering superior customer service and product support, backed by the
most comprehensive product offering.
Involved in design, manufacturing and marketing innovative implants for spinal pathologies, Eurospine is
placed in a permanent high-tech position within the spinal industry. The innovation and the research and
development are the two key elements which enable Eurospine products to be well-known in the world.
Eurospine’s team of research works closely with distinguished surgeons, neurosurgeons and orthopedists.
Thanks to rigorous work and the close co-operation between all the collaborators, Eurospine succeeded in
introducing very innovative products of outstanding quality.
Fannin Spine are a dedicated supplier of niche within a niche spinal products to the UK and Ireland. We are
exclusive distributors for paradigm non-fusion products like Coflex, Lifenet ambient temperature allograft,
FH-Ortho visco-elastic lumbar and cervical discs, Signus spinal implants including Rabea and Spineview
endoscopic spinal surgery.
Haag-Streit UK designs, manufactures and sells a complete line of optometry and ophthalmic equipment
and has distributorships for some leading brands such as Haag-Streit Diagnostics, Clement Clarke
Ophthalmic, CenterVue, Ellex, Haag-Streit Surgical and Optovue. The organisation is dedicated to
providing tailored solutions through the integration of information technology, leading brand ophthalmic
instruments and unparalleled customer care.
Highland Medical enjoys a reputation as one of the leading marketers and distributors of medical devices
in the United Kingdom healthcare industry. We strive to develop mutually beneficial productive alliances
and partnerships that will advance our capability to provide innovative and cost-effective devices. We
sustain an ethos of excellence and integrity creating great results for all our stakeholders.
Horatio’s Garden www.horatiosgarden.org.uk is a charity that creates and cares for beautiful accessible
gardens in NHS spinal injury centres. Leading garden designers develop the stunning sanctuaries for
patients and their family and friends, creating an environment which becomes an integral part of their lives
and care whilst spending many months in hospital.
The Improving Spinal Care project is working with patients to transform spinal services across England.
The national care pathway for low back and radicular pain provides seamless care from GP practice to
specialist spinal services. The regional spinal networks are designed to optimise treatment, shorten
hospital stays and improve patient outcomes.
JRI Orthopaedics are pleased to introduce the Finceramica range of Orthobiologics for use in spinal
applications, including RegenOss. This biomimetic scaffold is created by nucleating bone like
nanostructured non-stoichiometric hydroxyapatite into self-assembling collagen fibres, as occurs in the
biological neo-ossification process. Come visit our stand to learn more.
LDR is a global medical device company focused on designing and commercialising novel and proprietary
surgical technologies for the treatment of patients suffering from spine disorders. Our primary products
are based on our VerteBRIDGE® fusion and Mobi® non-fusion platforms, both of which are designed for
applications in the cervical and lumbar spine. More information at www.ldr.com.
The Leica Microsystems Medical Division’s focus is to partner with and support surgeons and their care
of patients with the highest-quality, most innovative surgical microscope technology today and into the
future. Leica Microsystems has seven major plants and product development sites around the world. The
company is represented in over 100 countries, has sales and service organisations in 20 countries and an
international network of distribution partners. Its headquarters are located in Wetzlar, Germany.
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Other sponsors
Lindare Medical are proud to be sponsoring BritSpine 2016. Please visit our stand to take a look at our
innovative range of spinal implants and techniques. We trust you will have an enjoyable meeting and look
forward to speaking with you soon.
Macromed work in partnership with leading independent manufacturers to deliver cutting edge
technologies to the UK; revolutionary icotec Carbon-PEEK systems, EIT 3D printed cellular titanium
cages and the class leading Ulrich Medical cervical spine portfolio stand out. Please visit our booth for
more information on how these technologies can help provide optimal treatment for your patients.
Mastery, Balance, Accountability
MBA are a leading European company in the healthcare technology market. MBA currently specialises
in orthopaedic and neurosurgical solutions with a focus on spinal surgery, biologics and lower limb
arthroplasty. We have an experienced team of account managers offering technical/clinical support
based across the UK.
Medicrea is a French manufacturer specialising in the design, development, manufacture and
distribution of spinal implants with 4 direct sales subsidiaries in the USA, UK, Germany and France, plus
distribution in over 30 countries worldwide. The company focuses on introducing key innovations and
making a clinical contribution in complex spinal surgeries.
Melyd Medical are dedicated to patient positioning for all surgeries. We are proud to show our new
Schaerer operating table with carbon-fibre spine attachment. This system provides a number of
advantages over traditional two-column four-post tables:
- Full 360 degree radiolucency
- Four-post with adjustable headrest
- Excellent anaesthetist access
- Multi-discipline table therefore more cost efficient
Mercian has been established since 1968 with a reputation for innovative and specialised high quality
spinal instrumentation. We have a comprehensive range of spinal instrumentation for applications in
the areas of lumbar, cervical and anterior spinal surgery. We will be showing our specialist range of spinal
retractor systems for cervical and lumbar spinal surgery including the McCulloch Micro Discectomy
Retractor and Black Belt Cervical Retractor. We have a new dedicated lumbar spine instrument set
featured on our stand with all the instruments a surgeon requires for lumbar spine surgery.
The North American Spine Society (NASS) is a global multidisciplinary medical society that utilizes
education, research and advocacy to foster the highest quality, ethical, value and evidence-based
spine care for patients. Representing over 8,000 members from multiple specialties, NASS is your link to
health care professionals invested in advancing spine care.
Established in 1990, Neurotechnics, now part of the Pharmed Group, provides innovative, high quality
surgical solutions for the spine. This year at BritSpine we are pleased to be able to demonstrate Mizuho
OSI’s Spinal Tables, Misonix’s groundbreaking BoneScalpel and High Speed Drills from Adeor. For
further information call 0845 450 0590.
Headquartered in Redwood City, California, Nevro is a global medical device company focused on
providing innovative products that improve the quality of life of patients suffering from debilitating
chronic pain. Nevro has developed and commercialised the Senza Spinal Cord stimulation (SCS) system,
an evidence-based neuromodulation platform for the treatment of chronic pain.
The NHS Tissue Bank in Liverpool is the largest retrieval and storage facility for human tissue in the
UK. We operate as a not-for-profit organisation responsible for the entire supply chain co-ordinating,
recovering, processing and bank tissue. Our unique service offers a wide range of tissue for spinal
surgery.
We improve people’s mobility. Össur are a globally recognised business working on the manufacture
and distribution of non-invasive orthopaedic solutions, including prosthetics and braces and supports.
Our clinically proven designs are the culmination of over 40 years of knowledge with a specific focus on
enhancing a patient’s mobility.
PHF Services will take the headache out of running your private practice. We use the latest software
solutions to ensure you will have more time to do what you do best - care for your patients. Visit PHF to
see how we can help you and your private practice work smarter - telephone 0845 556 1220 for more
information.
BRITSPINE 2016
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Other sponsors
Premia Spine (www.betterthanspinalfusion.co.uk/www.premiaspine.com) is commercialising the TOPS™
system, a posterior lumbar device for spinal stenosis and spondylolisthesis. TOPS is a mobile implant that
recreates flexion, extension, lateral bending, axial rotation and sagittal translation. Patients experience
immediate and sustained pain relief and function as demonstrated by clinical trials since 2005.
Premium Medical Protection provides bespoke medical professional indemnity insurance, aiming to
lower premiums whilst continuing to provide comprehensive cover up to £10m limit of liability and
benefits such as consent to settle and indefinite run off into retirement (subject to underwriting). Call
0845 3082350 or www.premiummedicalprotection.com.
Working side-by-side with surgeons, QSpine designs, manufactures and distributes some of the most
innovative products on the market. A small UK company, QSpine continues to exceed expectations by
sourcing or developing products that will drive spinal surgery forward. Our team of committed spine
specialists are uniquely placed to support you.
Rex Bionics sells two products - the REX and REX P. REX is available to rehabilitation centres and
hospitals. It is quickly adjusted to fit multiple users for robot assisted physiotherapy and walking. REX
P is custom fitted to one user and is used either in the home or at work. Used by people with SCI, stroke
and other mobility impairments.
RTI Surgical is a leading global surgical implant company providing surgeons with biologic, metal and
synthetic implants. Committed to advancing science, safety and innovation, RTI’s implants are used in
sports medicine, general surgery, spine, orthopedic, trauma and cardiothoracic procedures. RTI Surgical
is present in Europe with company locations in Germany, The Netherlands and France.
SI-Bone is a leading sacroiliac joint medical device company dedicated to the development of tools
and products for patients with low back issues related to SI joint disorders. Clinical studies have
demonstrated that treatment with the iFuse Implant System® improved pain, patient function and
quality of life at 12 months post-implantation.
On a daily basis, surgeons around the world rely on Spierings’ unique Noviomagus products in spine,
hip, knee and trauma surgery. The bone mills, reamers and bone harvesting device are highly respected
because of their durability, ease of use and sublime characteristics, securing the same results over
and over again. Furthermore, the very long life-span of the products helps in saving costs and is also
beneficial to the environment. Quality and usability are the most important criteria of our products;
that is the wish of our customers and that is the focus of Spierings Orthopaedics.
Specialists in Spinal Cord Monitoring during spinal and neurosurgical procedures, we perform full
multi-modality neuromonitoring during surgery aiming to improve patient outcome. Providing the
most advanced methods of monitoring by the most experienced neurophysiologists. Working with the
NHS, private hospitals and supporting medical companies throughout the UK and overseas.
SpineGuard provides tools equipped with Dynamic Surgical Guidance (DSG) technology to enhance
spinal surgery. Devices built with DSG technology give real-time audio and visual feedback to improve
the accuracy of pedicle screw placement, without the need for ancillary equipment. The PediGuard
probes are the only devices with built-in DSG capability. These devices have assisted spine surgeons in
accurately placing pedicle screws in over 43,000 spinal procedures around the world. Please visit www.
spineguard.com for more information.
Spring Active is an evidence-based provider of back pain services. We provide innovative digital and
physical programmes following a biopsychosocial model in order to improve clinical care whilst reducing
the cost of delivery. Spring Active products and services offer advice, information and education on the
nature of back pain.
Tiger Medical Supplies bring innovation, quality and the expertise you require. We look forward to
meeting you at BritSpine in Nottingham where you can find out more about our full spinal products,
generic and niche, as well as endoscopic, specialist RF, reusable and single use instruments.
Allen Medical and Trumpf Medical, both part of Hill-Rom, is distinguished by high-quality engineering
standards and offers innovative products to improve efficiency and safety in the operating room and
other clinical environments throughout the care sector. With our customers’ requirements as our
benchmark and innovation as the foundation of our success, Trumpf Medical UK delivers total solutions
to fit your clinical care needs.
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Other sponsors
Twelve-By-Seventy-Five is a Fine Wine Merchants and Brokers that supply you with the very best
the wine world has to offer. We specialise in investment and consumption wine and have on hand
consultants to help you every step of the way to making the right choice.
The United Kingdom Spine Societies Board Ltd (UKSSB) is an organisation composed of 3 national
societies that are members of the UKSSB:
- Society for Back Pain Research (SBPR)
- British Scoliosis Society (BSS)
- British Association of Spine Surgeons (BASS)
The Board includes representatives of the British Orthopaedic Association (BOA) and the Society of
British Neurological Surgeons (SBNS).
Vesalius is a surgical sales and marketing company, specialising in the distribution of medical devices
used to treat patients undergoing spinal surgery. Thanks to its exclusive partnerships with leading spinal
companies across Europe, Vesalius provides spinal surgeons in the UK and Ireland with comprehensive
solutions to complex surgical procedures.
Vexim provides minimally-invasive solutions for A-type vertebral fractures. A range of zero-inertia
vertebroplastly therapies are offered as well as the SpineJack for controlled anatomical restoration.
SpineJack has been designed to anatomically restore a collapsed vertebral body with cranio-caudal
control when opening the implant.
Did you know?
Tissue and Eye Services can supply you with:
Demineralised Bone Matrix (DBM)
Freeze Dried Bone
Femoral Heads
Tendons
To find out more
our Tissue Product Specialists are
Why you should come to us first
available to answer your questions
☑ Ethically sourced from UK donors
☑ From the NHS for the NHS
☑ Use with confidence – a specialist service
☑ Largest Tissue Bank in the UK
☑ Cost effective.
at BRITSPINE
Stand Number 27
BRITSPINE 2016
(Level 0)
130
Exhibitors’ Names and Stand Numbers
In stand number order for each level
LEVEL 1
LEVEL 0
NO.
NO.
1
Neurotechnics
27
NHS Blood and Transplant
2
Rex Bionics
28
Premium Medical Protection
3
B Braun Medical Ltd
29
Twelve by Seventy Five
4
Spierings Orthopaedics
30
Macromed
5
JRI Orthopaedics
31
Leica Microsystems
6
Lindare Medical
32
Nevro
7
K2M
8a
Silony Medical
Bronze Sponsor
35
Zimmer Biomet
8b
Globus
Bronze Sponsor
36
Haag Streit
9
Stryker
Gold Sponsor
10
SI-Bone
39
Trumpf Medical
11
Premia Spine
40
Spring Active
12
Medicrea
41
Backcare
12a Anchor Orthopaedics
42
Spinal Cord Monitoring
14
Tiger Medical
43
Baxter Healthcare
15
RTI Surgical
44
DePuy Synthes
16
Melyd Medical
45
Brainlab
17
Eurospine
46a
ApiFix
18
MBA Surgical UK Ltd
46b
Highland Medical
19
British Spine Registry
46c
Alchemy DKG
20
Improving Spinal Care
46d
PHF Services
20a SAUK/BSRF
47
NuVasive
21
Horatio’s Garden
48
Össur UK
22
Cauda Equina
49
Fannin Spine
23
AOSpine
50
Vexim
23a CAUK
51
Mercian Surgical
24
NASS
52
Vesalius
25
BOA
53
Edge Medical
26
UKSSB
53a
SpineGuard
54
Medtronic
55
QSpine
131
Gold Sponsor
33/34 Alphatec Spine
Silver Sponsor
Bronze Sponsor
37/38 LDR Medical
Gold Sponsor
Gold Sponsor
Silver Sponsor
BRITSPINE 2016
Exhibitors’ Names and Stand Numbers
In alphabetical order for each level
LEVEL 1
LEVEL 0
NO.
NO.
12a Anchor Orthopaedics
46c
Alchemy DKG
23
AOSpine
33/34 Alphatec Spine
3
B Braun Medical Ltd
46a
ApiFix
25
BOA
41
Backcare
19
British Spine Registry
43
Baxter Healthcare
22
Cauda Equina
45
Brainlab
44
DePuy Synthes
23a CAUK
17
Eurospine
Bronze Sponsor
53
Edge Medical
8b
Globus
Bronze Sponsor
49
Fannin Spine
21
Horatio’s Garden
Gold Sponsor
36
Haag Streit
20
Improving Spinal Care
7
K2M
6
Gold Sponsor
37/38 LDR Medical
31
Leica Microsystems
Lindare Medical
30
Macromed
18
MBA Surgical UK Ltd
54
Medtronic
12
Medicrea
51
Mercian Surgical
16
Melyd Medical
32
Nevro
24
NASS
27
NHS Blood and Transplant
1
Neurotechnics
47
NuVasive
5
JRI Orthopaedics
48
Össur UK
11
Premia Spine
46d
PHF Services
2
Rex Bionics
28
Premium Medical Protection
15
RTI Surgical
55
QSpine
20a SAUK/BSRF
42
Spinal Cord Monitoring
10
SI-Bone
53a
SpineGuard
8a
Silony Medical
40
Spring Active
4
Spierings Orthopaedics
39
Trumpf Medical
9
Stryker
29
Twelve by Seventy Five
14
Tiger Medical
46b
Highland Medical
26
UKSSB
BRITSPINE 2016
Silver Sponsor
Gold Sponsor
Bronze Sponsor
Gold Sponsor
52
Vesalius
50
Vexim
35
Zimmer Biomet
Silver Sponsor
Gold Sponsor
Bronze Sponsor
132
ALTERNATIVE FIXATION
View our comprehensive product portfolio at NASS Booth #1139.
1.866.526.4171 | www.K2M.com
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BRITSPINE 2016
Official Gold Sponsor of BritSpine 2016
12 new products
12 new reasons
to come and visit Stryker Spine
Stand 9, Level 1
•HYGRO Porous
Titanium cage
•Aero AL Anterior Cage
•Troflex Curved Needle
•Spinemask MIS Navigation
•Bodytom Intra Operative CT
•ES2 MIS Screw
•ES2 Multi-Level
Compression Distractor
•Pedicle Based Retractor
MIS TLIF
•LITe Anterior Retractor
•Anchor L Anterior Cage
•LITe Anterior Plates
•UNIVise Interspinous fixation
BRITSPINE 2016
134
Dates for your Diary
2016
2017
2018
Apr
Wed 20-Fri 22
SBNS Spring Meeting - The Sage, Newcastle-upon-Tyne
Sep
Tue 13-Thu 15
BOA Congress - Belfast Waterfront
Sep
Wed 21-Fri 23
SBNS Autumn Meeting - Telford
Oct
Wed 5-Fri 7
Eurospine - Berlin
Oct
Thu 3-Fri 4
SBPR Annual Meeting – Barton Grange Hotel, Preston
Nov
Thu 13-Fri 14
BSS Annual Conference Hardwick Hotel, Sedgewick, Middlesbrough
Mar
TBA
BASS Annual Conference Manchester
Mar
TBA
SBNS Spring Meeting - Oxford
Apr
TBA
BSS Annual Conference - Birmingham
Oct
Wed 11-Fri 13
Eurospine - Dublin
TBA
TBA
BritSpine 2018 University of Leeds
The Royal National Orthopaedic Hospital (RNOH) now offers a range of hip, knee
and spine implant retrieval analysis services to support surgeons in their clinical
decision making and patient management.
This hospital-to-hospital NHS service is available for retrieved implants from
surgeons and uses advanced metrology methods to evaluate the extent and
patterns of in vivo damage to identify cause of failure differentiating between
surgeon and implant factors.
For more information please visit www.rnoh.nhs.uk/retrieval-analysis
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Notes
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Notes
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BRITSPINE 2016