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CT fusion imaging as a preoperative planning tool for patients undergoing revision adult spinal deformity surgery
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Proceedings of the BASS 2015 Bath Meeting / The Spine Journal 15 (2015) 50S–85S
important when planning surgery for spinal stenosis or rehabilitation for low back pain. CONFLICTS OF INTEREST: None. FUNDING SOURCES: European Academy of Chiropractic. http://dx.doi.org/10.1016/j.spinee.2014.12.051
SPECT/CT fusion imaging as a preoperative planning tool for patients undergoing revision adult spinal deformity surgery J.S. Butler, J.J.H. Leong, M.D. Sewell, A. Benton, J. Platinum, M.L. Suarez-Huerta, S. Selvadurai, S. Molloy; Spinal Deformity Unit, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex BACKGROUND CONTEXT: Revision adult spinal deformity surgery is a speciality requiring careful patient selection and meticulous preoperative planning. Often standard imaging modalities offer equivocal or inadequate information for operative planning. PURPOSE: To evaluate the efficacy and utility of SPECT/CT as a diagnostic modality and preoperative planning tool in patients undergoing revision adult spinal deformity surgery. STUDY DESIGN/SETTING: A prospective cohort study (n516) performed over a 3-year period at a major tertiary referral centre for adult spinal deformity surgery. PATIENT SAMPLE: All consecutive patients requiring 1-stage, 2-stage or 3-stage revision sagittal plane deformity correction were included. OUTCOME MEASURES: Clinical outcome measures included EQ-5D, EQ-5D VAS, SRS-22, ODI and VAS Pain Scores. METHODS: SPECT/CT fusion imaging was performed preoperatively in conjunction with standard radiographs, normal CT and MRI. Clinical outcome measures were collected preoperatively and at 6 weeks, 6 months, 1 year and 2 years postoperatively. RESULTS: SPECT/CT fusion imaging demonstrated increased sensitivity for identifying regions of suspected pseudoarthrosis and facet degeneration when compared to both standard CT and MRI. There was a significant improvement in all clinical outcome measures assessed preoperatively and followed out to 2-years postoperatively. Mean ODI score improved from 53.88 to 12.0; VAS back pain score improved from 7.25 preoperatively to 2.0; VAS leg pain score improved from 4.38 to 0.91. CONCLUSIONS: SPECT/CT fusion imaging is an excellent tool for the preoperative evaluation and management of patients requiring revision spinal deformity surgery. SPECT/CT identifies specific focal areas of pathology, including pseudoarthrosis and facet degeneration, enabling more accurate level selection for revision fusion surgery. Furthermore, this imaging modality was associated with excellent postoperative health related quality of life (HRQOL) outcome measures. CONFLICTS OF INTEREST: None. FUNDING SOURCES: None. http://dx.doi.org/10.1016/j.spinee.2014.12.052
Developing a nurse-led nerve root block service Gill Rhind, Charles Greenough; South Tees Hospitals Foundation Trust, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW BACKGROUND CONTEXT: Changes within the NHS have led to innovative ways of working for nurses, with the expansion of roles into what was traditionally seen as medical. Delays in waiting for both therapeutic and diagnostic Nerve Root Blocks means meeting the 18-week target has been challenging within Orthopaedic Spinal Departments.
PURPOSE: The Purpose of introducing a nurse-led Nerve Root Block service was to provide a safe and effective service whilst meeting the18week targets. STUDY DESIGN/SETTING: Service review. PATIENT SAMPLE: 272 patients. METHODS: This paper describes the development of the nurse-led Nerve Root Block service, and discusses the training and collaborative working within the service. Despite extensive searches it was concluded that there was no formal training programmes to meet this situation, therefore one was developed using a WASP framework and the nurse spent 6 months shadowing a Consultant Interventionist Radiographer. All patients were reviewed by the referrer via telephone or outpatient consultation. RESULTS: A fast-track service for patients requiring diagnostic as well as therapeutic Nerve Root Blocks was set up in June 2013. Patients are pre-assessed, consented and receive their block within an outpatient radiology department. A service review of 272 patients was carried out, demonstrating 61% were discharged after one injection, with 54% of these reporting total pain relief or having significant sustained pain relief, 20% were listed for surgery and 20% for further investigations. Patients waiting times for Nerve Root Block have reduced from 18 weeks to 3 weeks. CONCLUSIONS: A nurse-led fast-track service is a safe and effective means of meeting the 18-week pathway. CONFLICTS OF INTEREST: None. FUNDING SOURCES: None. http://dx.doi.org/10.1016/j.spinee.2014.12.053
Spinal Infection Surgical percutaneous biopsy of discitis and vertebral osteomyelitis is significantly better than CT guided biopsy in identifying the causative organism Radu Popa, Luigi Magnano, Hanny Anwar, Lester Wilson; The Royal National Orthopaedic Hospital, Stanmore BACKGROUND CONTEXT: CT guided biopsy and blood cultures have become the most commonly taken samples in the search to identify the pathogen in discitis/osteomyelitis but have low reported yield rates. By performing surgical biopsy in theatre with fluoroscopy, the surgeon can ensure biopsy of the endplate and disc. PURPOSE: To identify whether surgical biopsy in theatre improves biopsy yield rates versus CT-guided biopsy. STUDY DESIGN/SETTING: Retrospective review of current service. PATIENT SAMPLE: 30 consecutive patients referred to our institution with spinal infection. OUTCOME MEASURES: Culture of causative organism. METHODS: The clinical records of patients were reviewed to ascertain clinical presentation, treatment prior to biopsy, result of biopsy and final outcome. RESULTS: CT guided biopsy found the causative organism in 50% of patients, while surgical biopsy found the causative organism in 72% of patients (P!0.05). CONCLUSIONS: This retrospective pilot-study demonstrates improved potential for confirming the causative organism in spinal infection with surgical biopsy. We intend to establish a prospective randomised control trial to confirm this. CONFLICTS OF INTEREST: None. FUNDING SOURCES: None. http://dx.doi.org/10.1016/j.spinee.2014.12.055
Proceedings of the BASS 2015 Bath Meeting / The Spine Journal 15 (2015) 50S–85S
important when planning surgery for spinal stenosis or rehabilitation for low back pain. CONFLICTS OF INTEREST: None. FUNDING SOURCES: European Academy of Chiropractic. http://dx.doi.org/10.1016/j.spinee.2014.12.051
SPECT/CT fusion imaging as a preoperative planning tool for patients undergoing revision adult spinal deformity surgery J.S. Butler, J.J.H. Leong, M.D. Sewell, A. Benton, J. Platinum, M.L. Suarez-Huerta, S. Selvadurai, S. Molloy; Spinal Deformity Unit, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex BACKGROUND CONTEXT: Revision adult spinal deformity surgery is a speciality requiring careful patient selection and meticulous preoperative planning. Often standard imaging modalities offer equivocal or inadequate information for operative planning. PURPOSE: To evaluate the efficacy and utility of SPECT/CT as a diagnostic modality and preoperative planning tool in patients undergoing revision adult spinal deformity surgery. STUDY DESIGN/SETTING: A prospective cohort study (n516) performed over a 3-year period at a major tertiary referral centre for adult spinal deformity surgery. PATIENT SAMPLE: All consecutive patients requiring 1-stage, 2-stage or 3-stage revision sagittal plane deformity correction were included. OUTCOME MEASURES: Clinical outcome measures included EQ-5D, EQ-5D VAS, SRS-22, ODI and VAS Pain Scores. METHODS: SPECT/CT fusion imaging was performed preoperatively in conjunction with standard radiographs, normal CT and MRI. Clinical outcome measures were collected preoperatively and at 6 weeks, 6 months, 1 year and 2 years postoperatively. RESULTS: SPECT/CT fusion imaging demonstrated increased sensitivity for identifying regions of suspected pseudoarthrosis and facet degeneration when compared to both standard CT and MRI. There was a significant improvement in all clinical outcome measures assessed preoperatively and followed out to 2-years postoperatively. Mean ODI score improved from 53.88 to 12.0; VAS back pain score improved from 7.25 preoperatively to 2.0; VAS leg pain score improved from 4.38 to 0.91. CONCLUSIONS: SPECT/CT fusion imaging is an excellent tool for the preoperative evaluation and management of patients requiring revision spinal deformity surgery. SPECT/CT identifies specific focal areas of pathology, including pseudoarthrosis and facet degeneration, enabling more accurate level selection for revision fusion surgery. Furthermore, this imaging modality was associated with excellent postoperative health related quality of life (HRQOL) outcome measures. CONFLICTS OF INTEREST: None. FUNDING SOURCES: None. http://dx.doi.org/10.1016/j.spinee.2014.12.052
Developing a nurse-led nerve root block service Gill Rhind, Charles Greenough; South Tees Hospitals Foundation Trust, James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW BACKGROUND CONTEXT: Changes within the NHS have led to innovative ways of working for nurses, with the expansion of roles into what was traditionally seen as medical. Delays in waiting for both therapeutic and diagnostic Nerve Root Blocks means meeting the 18-week target has been challenging within Orthopaedic Spinal Departments.
PURPOSE: The Purpose of introducing a nurse-led Nerve Root Block service was to provide a safe and effective service whilst meeting the18week targets. STUDY DESIGN/SETTING: Service review. PATIENT SAMPLE: 272 patients. METHODS: This paper describes the development of the nurse-led Nerve Root Block service, and discusses the training and collaborative working within the service. Despite extensive searches it was concluded that there was no formal training programmes to meet this situation, therefore one was developed using a WASP framework and the nurse spent 6 months shadowing a Consultant Interventionist Radiographer. All patients were reviewed by the referrer via telephone or outpatient consultation. RESULTS: A fast-track service for patients requiring diagnostic as well as therapeutic Nerve Root Blocks was set up in June 2013. Patients are pre-assessed, consented and receive their block within an outpatient radiology department. A service review of 272 patients was carried out, demonstrating 61% were discharged after one injection, with 54% of these reporting total pain relief or having significant sustained pain relief, 20% were listed for surgery and 20% for further investigations. Patients waiting times for Nerve Root Block have reduced from 18 weeks to 3 weeks. CONCLUSIONS: A nurse-led fast-track service is a safe and effective means of meeting the 18-week pathway. CONFLICTS OF INTEREST: None. FUNDING SOURCES: None. http://dx.doi.org/10.1016/j.spinee.2014.12.053
Spinal Infection Surgical percutaneous biopsy of discitis and vertebral osteomyelitis is significantly better than CT guided biopsy in identifying the causative organism Radu Popa, Luigi Magnano, Hanny Anwar, Lester Wilson; The Royal National Orthopaedic Hospital, Stanmore BACKGROUND CONTEXT: CT guided biopsy and blood cultures have become the most commonly taken samples in the search to identify the pathogen in discitis/osteomyelitis but have low reported yield rates. By performing surgical biopsy in theatre with fluoroscopy, the surgeon can ensure biopsy of the endplate and disc. PURPOSE: To identify whether surgical biopsy in theatre improves biopsy yield rates versus CT-guided biopsy. STUDY DESIGN/SETTING: Retrospective review of current service. PATIENT SAMPLE: 30 consecutive patients referred to our institution with spinal infection. OUTCOME MEASURES: Culture of causative organism. METHODS: The clinical records of patients were reviewed to ascertain clinical presentation, treatment prior to biopsy, result of biopsy and final outcome. RESULTS: CT guided biopsy found the causative organism in 50% of patients, while surgical biopsy found the causative organism in 72% of patients (P!0.05). CONCLUSIONS: This retrospective pilot-study demonstrates improved potential for confirming the causative organism in spinal infection with surgical biopsy. We intend to establish a prospective randomised control trial to confirm this. CONFLICTS OF INTEREST: None. FUNDING SOURCES: None. http://dx.doi.org/10.1016/j.spinee.2014.12.055