POST OPERATIVE SPINAL SURGERY NEUROLOGICAL OBSERVATION – HOW GOOD ARE YOU?

Abstract

There are currently no agreed guidelines for the type and frequency of post spinal surgery neurological observations. This lack of an agreed standard can lead to the failure to adequately monitor cord function following surgery and thus neurological deficits can be missed. We have carried out an audit of the postoperative spinal observations against our agreed standards of care.

Standards of care:

1. All patients should have the frequency of required neuro obs documented in the post op instructions.

2. The frequency of documented observations in recovery should be adhered to.

3. The frequency of documented observations in HDU should be adhered to.

4. Any neurological loss should be properly documented.

5. The nurses will report any neurological change promptly

6. The SHO will exam and document a full neurological examination.

28 case notes were reviewed. 21 of these cases were scoliosis correction through anterior, posterior and combined approaches. 3 had disc replacements, 2 had decompression for metastatic cancer and one had fixa-tion of a fracture.

All patients failed to complete all standards fully. There was a lack of clear postoperative guidelines, failure to record neurological status in recovery, incomplete documentation of neurological state in HDU, failure to inform medical staff in presence of a neurological deficit and inadequate assessment of patient by medical staff. One patient returned to theatre for a foot drop, which is still only partially recovered.

We recommend the audit of current practice and implementation of locally agreed standards for the postoperative monitoring.