Purpose of study and background

Spinal surgery is a high-risk surgical speciality, a patient's understanding of surgical interventions, alternative treatment options, and the benefits and risks must be ascertained to gain informed consent. This pilot study aims to evaluate if the provision of a digital recording of a patient's consultation enhances patient satisfaction, improves recall of clinical diagnosis, recall of treatment options and the risks and benefits of Spinal Surgery.

Purpose of Study and Background

Degenerative cervical myelopathy resulting in cord compromise is a progressive condition that results in significant quality of life limitations. Surgical treatment options available are anterior and/or posterior decompression of the affected levels. Patients are counselled pre-operatively that the aim of surgical intervention is to help prevent deterioration of neurology. Anecdotal evidence suggested improvements in both EMS and PROMs in this cohort of patients. A 2-year prospective study tested this hypothesis.

Purpose of Study/Background

To identify whether patients were satisfied with the overall educational component of the specialist nurse (CNS)/occupational therapist (OT) led pre-operative assessment clinic in order to identify areas which required improvement.

The pre-operative specialist nurse led clinic was set up in 2002. The aim was to provide high quality information to patients undergoing elective spinal surgery in order to manage expectations and optimise post-operative recovery. Initially the clinic was specialist nurse led however, in 2006 occupational therapy input was introduced in order to provide an increased depth of information in regard to function and activities of daily living post operatively. In addition this has allowed assistive equipment to be provided pre-operatively. The format of this clinic has enhanced the patient's journey by facilitating reduced length of stay and more timely discharge.

Aim

To investigate the role of websites in enhancing patients' understanding of reason and risk of surgery as a part of informed consent for elective un-instrumented lumbar spine surgery (EULSS).

Aim

Assess efficacy of caudal epidural injection with epidurogram with validated outcome measures.

Aim: To evaluate patient satisfaction between telephone and traditional outpatient appointments following un-instrumented spinal surgery.

Material and Methods: The study was approved by the local audit committee. Fifty seven patients who underwent un-instrumented lumbar spinal micro-decompressive surgery in 2008 were identified from Bluespiers database and were contacted by telephone. A predesigned proforma was used to collect data. Ten patients had not yet had follow-up at the time of study and were excluded. Results of 47 patients were analysed and are described. No loss to follow up was encountered.

Results: Average age was 60 (Range 23 to 89 years) with 21 male (45%) and 26 female (55%). Majority (77%) of patients rated telephone follow-up as good or excellent. Average delay between scheduled appointment time and contact with the clinician was 47 minutes in traditional clinic. Majority (84%) of patients were contacted in time in telephonic clinic with minority (16%) experienced an average delay of 28 minutes. Majority (93%) of patients would recommend telephone follow up clinic and (70%) reported telephone follow-up was better or much better than traditional clinic. Reasons for preferring telephone follow-up included delay in the clinic, saving travel time and no need to find parking space. Six percent were dissatisfied with telephone clinic the reason being hearing impairment and desire to discuss their condition face-to-face.

Conclusion: Telephone follow-up clinic for un-instrumented spinal surgery appears to be a safe cost effective satisfactory alternative for the majority of patients. However traditional clinical follow up may be required for a proportion of patients.

Conflict of Interest: None

Source of Funding: None

Current evidence on the indications for and efficacy of non-rigid lumbar stabilisation remains unclear. The aim of this study was to review the outcome of the DYNESYS system (Zimmer, Inc.) in a consecutive series of 34 patients undergoing this procedure between 2001 and 2006.

Prospectively collected outcome measure data obtained pre-operatively and at 1 year post-operatively was analysed using the Wilcoxon Signed Rank Test. Kaplan Meier survival analysis was performed using revision surgery as the end point. Cox Regression was utilised to identify variables that were related to implant survival.

Pain rating on the visual analogue scale improved from a mean of 7 pre-op to 4 at 1 year (p=0.009), Roland Morris Disability Questionnaire scores from 13 to 9 (p=0.02), Modified Somatic Perception Questionnaire from 13 to 9 (p=0.03). When reporting subjective outcome, 54% of patients reported “better” or “much better” outcomes at last followup (12–69 months post op). Eight patients (25%) required removal of the implant and conversion to fusion, one of whom had deep infection. Kaplan Meier survival analysis revealed a survival of 78% at 5 years (95% CI, 60 – 96%). Previous spinal surgery was significantly related to the time of survival of the implant (p=0.008).

Our study has demonstrated a high revision rate for this implant and 54% patient satisfaction. We recommend that patients be counseled regarding these risks and further use of this implant should be subject to the outcome of larger studies and randomised controlled trials.