PDF Statement: 210407 - BSS-BASS Statement.pdf

A recent publication of a paper in Bone and Joint Journal highlighted the “worse than death” quality of life scores for a number of patients in pain from arthritis of the hip and knee with lengthened wait times due to the COVID-19 pandemic.1

As spine surgeons managing patients in severe pain due to arthritic conditions as well as severe pain and despair from nerve root compression, we very much echo the concerns from our arthroplasty colleagues about our patient groups.

There are many patients now waiting many months for pain relieving interventions that have not been able to access elective lists due to the capacity issues related to the pandemic. These interventions usually come at the end of a conservative trial that has already failed, meaning that there is no other alternative for these patients whilst waiting. In addition, we have all seen patients progress to neurological compromise during the pandemic, requiring unplanned urgent or emergent surgery as a consequence. Unfortunately, on some occasions these can be irreversible changes. Children with spine deformity have also progressed in terms of their disease whilst waiting.

As organisations with clinician members concerned about the welfare of our patients, we urge that NHS bodies and Trusts work with us to find sustainable solutions to restart elective work in a safe way that allows equity of access to “COVID green” pathways, critical care facilities and MRSA screened facilities for spine surgery patients. We recognise that care needs to be focussed on clinical priorities, but welcome reassurance that the FSSA prioritisation categories are honoured regardless of underlying surgical condition. We also urge that resources are used to improve the well-being of all patients with awful pain that are awaiting surgery as soon as possible.

References:
1 https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.103B.BJJ-2021-0104.R1

Technology Enabled Care (TEC) Cymru in collaboration with British Association of Spine Surgeons (BASS) and United Kingdom Spine Societies Board (UKSSB) would like to invite you to the

“Fine Wine, Dine and Spine” Webinar Experience

17th March 2021 @ 8pm

Free Admission - register today!

This webinar aims to offer you more than just another ‘virtual talk’. We have a wine and dine experience to begin with, and some fascinating talks from experts across the country who will be reflecting on their learning and experience of using video consultations in their clinical practice during the COVID-19 pandemic.

Some of these innovative ways of working and lessons can be embedded in our future practice and this session will not only leave you with insights into future healthcare delivery but also some take home messages you could apply in your own work.

Register today at: http://www.spinesurgeons.ac.uk/FineWineDineSpine

BASS Clinical Management Update - IONM_final agreed version.pdf

Clinical Management Update - Intraoperative Neuromonitoring (IONM)

Background

IONM can reduce the risks of permanent neurological deficit associated with spinal surgery. However, whilst its use in certain spinal surgical procedures is well established there is currently no consensus view on the use of IONM in degenerative cases and in resection of intradural spinal cord tumours.

Indications for the use of IOM

The indications for spinal cord monitoring set out below are based on the results of a recent BASS / SBNS survey of its members(1) and a literature review(2-13).

Based on established and current practice, IONM is considered mandatory for the following procedures: correction of spinal deformity in the thoracic spine, DLIF/XLIF procedures and the reduction of a high-grade spondylolisthesis.

According to the results of the BASS/SBNS membership survey and a literature review, the use of IONM should be strongly considered for anterior thoracic discectomy and intramedullary tumour resection but is not mandatory. When used, the risks of neurological injury need to be balanced against the primary surgical aims of decompression and tumour resection.

According to the results of the BASS/SBNS survey and a literature review, the use of IONM is neither mandatory nor commonplace for the following procedures: cervical decompression for myelopathy, posterior thoracic decompression for myelopathy and resection of intradural extramedullary tumours.

The local availability of neurophysiological monitoring services, regional spinal network practices and agreements, and individual case factors should guide decision making for the use of IONM for all non-mandatory procedures.

Planning Intraoperative Neuromonitoring

No form of intraoperative monitoring is 100% specific or sensitive for detecting all injuries to the spinal cord or peripheral nerves but when well performed, relevant multimodal intraoperative neuromonitoring (MIONM) can approach this.

Clinical judgement must always be used to assess the risks associated with specific stages or manoeuvres during an operation.

Discussion of any planned IONM with the patient during the consenting process is advisable.

Preoperative planning of IONM techniques to be employed is critical to ensure relevant information can be obtained and good communication is critical to ensuring the information is delivered in a timely manner.

Confirm that the anaesthetist is aware that multimodal IONM is to be used to ensure appropriate anaesthetic and relaxant employed.

Where appropriate and safe, perform and document pre-positioning (and sometimes pre-intubation) baseline recordings in cases where there is a high risk associated with positioning. e.g. prone positioning for dislocation/severe myelopathy.

Establish baseline recording again prior to commencing surgery: normally continuing monitoring until closure.

Keep detailed records of any adverse monitoring events and remedial steps taken.

Neuromonitoring Modalities

Motor evoked potentials (MEPs) are normally best used in conjunction with free running electromyography (EMG) and somatosensory evoked potentials (SEPs).

Consider D-wave utilisation to provide additional monitoring of corticospinal tracts in intradural procedures, particularly intramedullary tumour cases.

Consider spinal mapping procedures to localise the midline where this is distorted (eg in intramedullary tumour surgery).

Consider direct nerve stimulation (DNS) to localise/identify roots where required.

Bilateral recording and recording above and below the operative level can be utilised to help locate problems e.g. to discriminate between artefactual, physiological (e.g. anaesthetic induced) and pathological changes in MEP/EP and sometimes D-wave recordings.

Management of reduction/loss MEP/SSEP prior to manipulation of neural tissue or correction of deformity

• Ensure that deterioration is not artefactual. Check lead connections. Ensure that muscle relaxants have not been administered.
• Consider correcting hypotension and hypothermia if present.
• Consider that deterioration could be positioning related. Consider returning patient to supine position.
• Consider “wake up test” to identify motor responses.

Management of reduction/loss of MEP/SSEP during direct manipulation of the spinal cord

• Discontinue manipulation of the cord for 5-15 mins and assess for improvement.
• Consider correcting hypotension or hypothermia if present.
• Consider dexamethasone bolus.
• If no improvement occurs with these manoeuvres then the surgeon will need to decide whether to proceed with surgery accepting the likelihood of significant post-operative deficit or to discontinue surgery. This decision will be individualised and take into account the patient’s underlying condition, rate of pre-surgical clinical deterioration, and likely prognosis.

Management of reduction/loss of MEP/SSEP during deformity correction surgery

• Ensure that deterioration is not artefactual. Check lead connections. Ensure that muscle relaxants have not been administered.
• Consider correcting any hypotension or hypothermia if present.
• Consider lightening the plane of anaesthesia. The use of the Bispectral Index and Spectral Edge Frequency can be helpful in determining the depth of anaesthesia.
• If no improvement occurs with these manoeuvres, then release all corrective measures and check screw positions with imaging.
• Wait to see if there is a return of normal MEP / SSEP.
• Consider “wake-up test” to identify motor responses.
• Consider discussion with colleague.

Acknowledgements

Dr Alan Forster, F.R.C.P., Consultant Clinical Neurophysiologist (for neurophysiology advice)

Mr Paul Brewer, Spinal Surgery ST6 (for literature review)

References:

1. A survey of surgeons’ use of intra-operative neurophysiological monitoring. BASS/SBNS. May 2019 (to be presented at Britspine 2021).

2. Value of intraoperative neurophysiological monitoring to reduce neurological complications in patients undergoing anterior cervical spine procedures for cervical spondylotic myelopathy. Parthasarathy D. Thirumala. Journal of Clinical Neuroscience 25 (2016) 27–35.

3. Intraoperative Neuromonitoring for Anterior Cervical Spine Surgery. What Is the Evidence? Remi M. Ajiboye, MD, et al. SPINE Volume 42, Number 6, pp 385–393.

4. Investigating the utility of intraoperative neurophysiological monitoring for anterior cervical discectomy and fusion: analysis of over 140,000 cases from the National (Nationwide) Inpatient Sample data set. Jetan H. Badhiwala, MD, et al. J Neurosurg Spine 31:76–86, 2019.

5. Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: a prospective analysis of 1055 consecutive patients. Michael O’Kelleher, et al. J Neurosurg Spine 8:215–221, 2008.

6. Surgery for Giant Calcified Herniated Thoracic Discs: A Systematic Review. Min Gong, et al. World Neurosurg. (2018) 118:109-117.

7. Anterior Transthoracic Surgery with Motor Evoked Potential Monitoring for High-Risk Thoracic Disc Herniations: Technique and Results. Erwin Cornips, et al. World Neurosurg. (2017) 105:441-455.

8. Comparison of intraoperative neurophysiologic monitoring outcomes between cervical and thoracic spine surgery. Shujie Wang, et al. Eur Spine J (2017) 26:2404–2409.

9. Intraoperative neurophysiological monitoring for intradural extramedullary spinal tumors: predictive value and relevance of D-wave amplitude on surgical outcome during a 10-year experience. Reza Ghadirpour, et al. J Neurosurg Spine 30:259–267, 2019.

10. Spinal intradural extramedullary tumors: the value of intraoperative neurophysiologic monitoring on surgical outcome. Ran Harel, et al. Neurosurg Rev (2017) 40:613–619.

11. Intraoperative Neuromonitoring in Patients with Intramedullary Spinal Cord Tumor: A Systematic Review, Meta-Analysis, and Case Series. Koen Rijs, et al. World Neurosurg. (2019) 125:498-510.

12. Diagnostic Utility of Intraoperative Neurophysiological Monitoring for Intramedullary Spinal Cord Tumors. Systematic Review and Meta-Analysis. Tej D. Azad, et al. Clin Spine Surg 2018;31:112–119).

13. Neuromonitoring for Intramedullary Spinal Cord Tumor Surgery. Terence Verla, et al. World Neurosurg. (2016) 95:108-116.

The organising committee of the Spinal TIG, invites centres not already registered to apply for the opportunity to host a spinal TIG fellow. This programme is an exciting curriculum-based training fellowship, combining neurosurgical and orthopaedic spinal surgical training for pre CCT fellows. Fellows are appointed by a competitive application and interview process centrally and once selected choose which centre to go to from the list of suitable centres. At the moment we have 10 centres in the programme: Leeds, Salford/Manchester, Liverpool, Bristol, Sheffield, Birmingham, Oxford, Cardiff, Preston, Stoke on Trent.

This year we have three STIG fellows – Alex Goubran, Alexander Durst and Sheweidin Aziz undertaking fellowships in Cardiff, Sheffield and Birmingham.

For 2021-22, we have funding in England for up-to three fellows, commencing in the summer of 2021 running for a one- year period. Under GMC regulations, the fellowships are pre CCT at this time, but will change to post CCT in due course. All fellowships are administered by the Severn Deanery and under the auspices of the JCST. We do not have funding at this time for centres outside England, and any centres applying from the rest of the UK and Ireland will be required to provide their own funding for fellows.

Applications require the completion of a Hospital Application Form (HAF) which sets out to establish the joint approach of training in the centre and the support of the local post graduate dean for the fellowship.

For application forms, or any queries, please contact Mr Niall Eames (Chair of the Spinal TIG Committee) via interface@jcst.org

Thank you for supporting this exciting combined training between neurosurgery and orthopaedic surgery in the exacting discipline of spinal surgery.

The Spinal TIG Committee - October 2021

Preliminary announcement

From - The Spinal Training Interface Group (STIG) Committee

We are delighted to announce that at least two STIG fellowships will soon be advertised to commence in summer 2021. These will be for PRE CCT trainees from both neurosurgery and orthopaedic surgery. Please note that the programme is changing to a post CCT fellowship in due course, but this round of appointments will be for PRE CCT trainees in 2021.

The STIG fellowship is designed to allow combined curriculum-based training between neurosurgery and orthopaedic surgery in the discipline of spinal surgery. Trainees will be appointed by competitive interview and will then select where they wish to undertake their fellowship from the list of suitable centres, all of which are leading spinal centres in the UK and Ireland, based around the spinal curriculum. The specialised training centres are listed on the JCST web site. These training placements provide joint training between Neurosurgery and Orthopaedic spinal surgery in established spinal centres. The fellowships will be undertaken as a period of Out of Programme Experience OOP(E).

This is the second year of these spinal TIG fellowships. Currently three STIGs are in post. We are delighted to be able to build on the success of this program and we will be advertising in the near future with interviews anticipated early in 2021 and posts commencing in summer 2021.

Further information is available in the JCST website or email myself at NiallEames@belfasttrust.hscni.net

Niall Eames

Chair Spinal TIG Committee

JCST

The British Association of Spine Surgeons (BASS) and the British Scoliosis Society (BSS) recorded six webinars for the British Orthopaedic Association 2020 Virtual Congress revalidation sessions. 

To view each of the videos, click the links below:

• Back Pain in Child and Young Adult
• Cauda Equina Syndrome (CES)
• MSCC
• Spinal Infections
• Spinal Trauma
• Spondyloarthritis

Mr. Kyle Martin McDonald FRCS

Consultant Spinal Surgeon, Belfast

Died Suddenly 26^th July 2020

It is with great sadness that we announce the sudden death of our esteemed colleague and friend Kyle McDonald.

Kyle was an exceptional Spinal surgeon who will be missed by patients and colleagues alike.

He was a loving husband to Poppy and devoted father of Darcey and Rory.

Kyle graduated from Queen’s University medical school and completed his orthopaedic training in Northern Ireland whilst gaining the Sir Walter Mercer Medal for the highest marks in the exit exam.  Upon completion of his training he embarked upon a fellowship in Scoliosis surgery in Dublin before returning as a Consultant in 2017.

This level of achievement summed up Kyle perfectly.  He was a supremely gifted and talented surgeon who made the hard things look easy. 

Patients and staff due to his carefree nature and quick wit loved Kyle.  His sense of humour was unrivalled.  He was a kind person who devoted his time to caring for his Scoliosis patients.  Nothing was too much trouble for him.

Above all Kyle cherished his beautiful family.  He valued the time he spent with his fantastic wife and darling children.

At this time we offer our deepest sympathies and love to Poppy, Darcey, Rory and the wider McDonald family.

Our team will never forget what Kyle brought to us.  We are weaker as a result. 

The UK spinal community has lost a young and talented surgeon, who had given so much and who could have given so much more.

Sadly Kyle was taken from us too soon but his legacy will be with us forever.  Rest in peace.

Obituary by Sam Sloan - Consultant Spinal Surgeon, Belfast Health and Social Care Trust

Following the webinar broadcast on 30th June 2020, we have now made the recording available  - to view the webinar, click here

The British Association of Spine Surgeons (BASS) are proud to present the first of many trainee-focused events with a session focused towards a career in spinal surgery.

Topic: So you want to be a Spinal Surgeon?

When: Tuesday 30th June 2020 - 8pm

Where: Zoom Online Webinar

Registration: Free of charge

To register, visit: https://us02web.zoom.us/webinar/register/WN_FxlGoCoVQHeWHYqE9z-WlA

This session will cover:

- Current training pathways in the UK, with an update on the Advanced 'In-Training' Fellowship in Spinal Surgery (a.k.a. STiG = Spinal Training Interface Group)

- What makes a good fellowship?

- Examples of post-CCT fellowship training in the UK and abroad with a discussion about what each route offers.

- There will also be ample opportunity to ask the panel questions via the Q&A tab.

The panel includes:

Host: Zacharia Silk (BASS Trainee Rep)

Speakers:

- Niall Eames (Consultant, Belfast)

- Hui-Ling Kerr (Consultant,

- Fahid Rasul (Fellow, Royal London Hospital)

- Zacharia Silk (Fellow, Great Ormond Street Hospital)

Moderators: Sashin Ahuja (BASS President) / Rajat Verma (BSS Education)

The event is free to attend and open to non-members too. Please share with your colleagues and trainees.

For those unable to attend, or wish to review the content again at a later stage, the webinar will be recorded and posted onto the BASS website, within the members section.

Details of how to become a BASS member can be found here: https://spinesurgeons.ac.uk/Member-Benefits

FAQs:

1. Is there a limit to the number of registrants?

There is no limit on registration, however our webinar platform the limit of attendees at any one time is 500, so when this reaches capacity during the webinar, no other users can enter. It is highly unlikely that we will hit this limit, but we do need to make attendees aware.

2. Will the event/webinar be recorded?

Yes - we plan to make the recording available to BASS members after the event. Previous Webinar recordings can be found on the members-only section of the BASS website.

3. Will the session interactive?

Yes - you are welcome to ask questions to the panel via the ‘Q&A’ function at the bottom of your screen. The panelists will do their best to answer your questions live, or write back to you.

4. Will I get a certificate?

Yes - following a completed feedback form which will be provided to attendees at the end of the event. Certificates will be sent the following week.

5. Can non-members attend?

Yes - this event is *freely available to surgeons (junior and senior), so please share amongst your colleagues and trainees.

* BASS reserve the right to email/contact non-members to suggest becoming BASS members in the future. Future webinars may be limited to members only.

This is the ninth webinar in our series of online educational events focused on delivering high quality spinal education to you at home.

Building on recent paediatric deformity sessions, this session will focus on the assessment and treatment Scheuermann's Kyphosis and Paediatric Spondylolisthesis.

Whilst aimed at post-CCT fellows, consultants, registrars and doctors from other grades are welcome to join. The event is free to attend and open to non-members too. Please share with your colleagues and trainees.

Topic: Paediatric Spondylolisthesis and Kyphosis
When: Tuesday 23rd June 2020 - 8pm
Where: Zoom Online Webinar
Registration: Free of charge

Host: Mr Zacharia Silk (BASS Trainee Rep)

Speakers:
- Mr Jonathan Lucas (London)
- Mr Ashley Cole (Sheffield)
- Mr Sashin Ahuja (Cardiff)

Moderators: Mr Rajat Verma (BSS Education), Mr Rohit Shetty (BASS Education)

To register, visit: 
https://us02web.zoom.us/webinar/register/WN_Pg_nSLZOR-e0xi-Y_Ny4-Q

For those unable to attend, or wish to review the content again at a later stage, the webinar will be recorded and posted onto the BASS website, within the members section.

FAQs:

1. Is there a limit to the number of registrants?
There is no limit on registration, however our webinar platform the limit of attendees at any one time is 500. It is highly unlikely that we will hit this limit, but we do need to make attendees aware.

2. Will the event/webinar be recorded?
Yes - we plan to make the recording available to BASS members after the event. Previous Webinar recordings can be found on the members-only section of the BASS website.

3. Will the session interactive?
Yes - you are welcome to ask questions to the panel via the ‘Q&A’ function at the bottom of your screen. The panelists will do their best to answer your questions live, or write back to you.

4. Will I get a certificate?
Yes - following a completed feedback form which will be provided to attendees at the end of the event. Certificates will be sent the following week.

5. Can non-members attend?
Yes - this event is *freely available to surgeons (junior and senior), so please share amongst your colleagues and trainees. 

* BASS reserve the right to email/contact non-members to suggest becoming BASS members in the future. Future webinars may be limited to members only.