bluuebunny/crossref_metadata_2025 huggingface dataset:
P26 Bridging the gap – benefits of neurosurgical tissue for pre-clinical research
Authors: Ahmed AI , Grundy PL , Vajramani G , Vargas-Caballero M , Willaime-Morawek S , Bulters DO
Published: February 2019

Objectives

The use of primary human neural tissue for research provides an invaluable insight into human neural function that cannot be achieved in any other way. Despite this it is successfully collected and used in only a small minority of units. We have established a collaboration between Neurosurgical Unit and the University that allows us to study using human tissue resected during neurosurgery. Tissue is most commonly collected from oncological, epilepsy and vascular operations. Here we share our experiences of the practicalities and try to provide some insights for practicing neurosurgeons.

Subjects

We discuss the practical difficulties of the co-ordination of the clinical and academic teams, and challenge of optimization of the tissue for the research. We will present the mechanisms in place to optimize the study of human neural tissue. We will review the progression from resection of limited tissue to any neurosurgical procedure in which the normal brain is resected and tissue discarded. We discuss the different models that can be used and the application locally to glioma stem cells, pathways activated in TBI and the electrophysiology of the normal brain.

Conclusions

We will present examples of the value of human tissue studies, including electrophysiological differences between humans and rodent that could only be investigated through the use of live human tissue. We will also demonstrate how we have moved to streamline tissue collection and propose a move to establish a national framework.
P29 Dissection using pulsed radiofrequency energy device (PlasmaBlade) is safe round implanted neuromodulation hardwares
Authors: Paterson A , Kumaria A , Sitaraman M , Sabbubeh T , Ingale H , Basu S
Published: February 2019

Objectives

To assess risk of damage to implanted neuromodulation hardware’s during dissection using the pulsed radiofrequency energy device (PlasmaBlade) in a simulated setting.

Design

Simulated experiment.

Methods

A simulated setting with fresh chicken breast threaded with different hardwires and PlasmaBlade in three configurations. Multiple substrates (wires), operators and observations were used representing typical hardware encountered in a functional neurosurgery service. Post dissection, the wires are inspected naked eye and under operating microscope. Induced current was assessed contemporaneously. A simple risk of physical and physiological damage is estimated.

Results

Five surgeons, of various grades, tested the PlasmaBlade at different CUT and COAG settings. Sixty dissections were undertaken. There was no structural damage and no induced current identified when PlasmaBlade was used at manufacturer recommended settings. At higher settings than would normally be used (CUT 6, COAG 5), there was opacification of insulation material of some wires (in 15 of 20 dissections; 75%), There was no dissolution of insulation even at this setting. Surgeons appreciated visibly lesser collateral damage to tissue and lesser smoke in the operative field using PlasmaBlade compared to conventional diathermy.

Conclusions

When used at recommended settings, PlasmaBlade dissection did not cause any damage to implant wiring or tubing in this simulated setting. This report seeks to add to clinical data suggesting PlasmaBlade dissection is safe for dissection around DBS, SCS, VNS, ITB hardware.
P32 Targeting accuracy of the neuromate robot in DBS implantation for paediatric dystonia
Authors: Ellenbogen JR , Narbad V , Hasegawa H , Selway R
Published: February 2019

Objectives

To quantify the accuracy of DBS electrode implantation for movement disorder in paediatric patients utilising the neuroinspire™ software and neuromate® robot.

Design

Retrospective, single-centre, cohort study.

Subjects

Fifteen patients with dystonia (67% female; median age 11 years, range 8–18 years) underwent intervention since May 2017.

Methods

DBS procedures were planned on the neuroinspire™ software and electrodes were implanted using the Renishaw neuromate® robot and Renishaw guide tubes and secured with a dog-bone plate under general anaesthetic. Post-operative CT imaging with the intra-operative O-arm was fused to pre-operative imaging. Planned entry and target coordinates were compared to actual entry and final target coordinates in order to obtain absolute and directional errors in x (medial-lateral), y (anterior-posterior) and z (dorsal-ventral) planes. Euclidean error was calculated for each electrode. Wilcoxon signed-rank test was used to analyse error.

Results

Bilateral GPi were targeted and Medtronic DBS systems were implanted for each patient (n=30). Overall median Euclidean error for electrode implantation was 2.13 mm (range, 0.71–4.85; p<0.001). No discrepancy between left- and right-sided electrodes was seen (p=0.346). Absolute errors in x (med 1.25 mm, range 0.10–4.10), y (med 0.80 mm, range 0–2.70) and z (med 1.45 mm, range 0–3.90) planes were individually significant (p<0.001). On overall anterior displacement of leads was observed (med 0.55+0.85 mm, p=0.001) but there was no significant directional bias in x (p=0.219) or z (p=0.077) planes.

Conclusions

We observed an improvement in the discrepancy seen between planned and actual lead location compared to a previously reported series using the Leksell frame in a similar cohort. Addressing possible compounding factors such as drilling techniques and electrode fixation should increase accuracy further. The neuromate® Robot is a reliable and accurate alternative to the Leksell frame.
P36 A 1 and 5 year outcome analysis of epilepsy surgery in adults and children
Authors: Chadwick A , Josan V , Pringle C , Pope O
Published: February 2019

Objectives

To evaluate the efficacy of epilepsy surgery at 1 year following surgery and to assess sustainability of seizure control at 5 years post-surgery. To find prognostic factors for good surgical outcomes.

Design

Retrospective case notes analysis.

Subjects

82 consecutive patients operated on for epilepsy by a single surgeon between 2008–2013.

Methods

Patients were identified in pre-existing hospital databases and included if 5 year follow-up was available. Their clinical records were accessed via the electronic patient records system at each site. The Engel Classification was used to grade seizure outcome at years 1 and 5 post-surgery. We classified Engel Class I and II as a good outcome and Engel class III and IV as a poor outcome. Case notes were also examined to find prognostic factors for a good long-term surgical outcome.

Results

86.4% of patients had a good outcome 1 year post-surgery and 77.9% had a good outcome at 5 years. The surgery site (temporal or otherwise) and the presence of a good outcome at year one were found to contribute significantly to odds of a good outcome at year 5. The ability to wean off medication is also commonly an important factor for patients and 24.4% of patients were AED free at 5 years.

Conclusions

Surgery is an effective management option for intractable epilepsy in suitably selected patients with complete or near complete seizure cessation in about 80% of the patients and about a quarter of the patients no longer requiring AEDs.
P39 Sphenoid sinus mucosal thickening in pituitary apoplexy: a link to abnormal microbiota
Authors: Waqar M , Humphreys G , McCreary R , McBain A , Karabatsou K , Kearney T , Gnanalingham K
Published: February 2019

Objectives

Sphenoid sinus mucosal thickening (SSMT) is described in small preliminary studies in the setting of pituitary apoplexy (PA). The aim of this study was to explore the possible association between PA and SSMT, and the microbial profile of SSMT.

Design

Single-centre case notes and tissue samples review (2007–2016).

Subjects

PA group: radiological/histologically confirmed PA; control group: non-functioning pituitary adenomas (NFPAs).

Methods

SSMT was measured on presenting MRI scans (pathological >1 mm). Forward stepwise logistic regression was used to identify factors associated with SSMT. Sphenoid sinus mucosal specimens were microbiologically profiled by PCR in a subset.

Results

Imaging arm: 50 NFPA and 47 PA patients included. In multivariate analysis of both the PA and NFPA groups, the presence of PA was the only factor associated with SSMT (OR=0.043, 95% CI 0.012 to 0.16; p<0.001). In multivariate analysis of the PA group alone, a shorter time from symptom onset to presenting MRI scan (OR=0.12, 95% CI 0.026 to 0.54; p=0.006) and more severe grade of apoplexy (OR=7.29, 95% CI 1.10–48.40; p=0.04), were associated with SSMT. Microbiological arm: 5 PA and 5 NFPA patients included. PA patients harboured microbiota similar to that seen in sinusitis, unlike NFPA patients.

Conclusions

SSMT is associated with PA, especially during the acute phase. SSMT is also associated with microbiota seen in sinusitis. Our results require further validation.
P41 Endoscopy in cerebellopontine angle lesions: feasibility and technical considerations
Authors: Oesman C , Alamri A , Khalil S , Wareing M , Saeed S , Bradford R , Paraskevopoulos D
Published: February 2019

Objectives

To define selection criteria and describe technique nuances for the use of endoscopy in surgery for cerebello-pontine angle (CPA) lesions.

Design

Prospective observational study.

Subjects

Patients undergoing CPA lesion resection were selected for endoscope-assisted and/or endoscope-guided lesion resection.

Methods

CPA interventions without mass lesions were excluded. 10 CPA lesions were identified pre-operatively for intra-operative endoscopic use across two neurosurgical centres. We describe equipment and technique selection.

Results

10 cases were selected over a one year period. Histology revealed 3 vestibular schwannomas (VS) (30%), 1 cyst (10%), 3 epidermoids (30%), 3 meningiomata (30%). Three cases were planned and carried out fully endoscopically (including two VS and the cyst) based on patient factors and favourable anatomy. Four cases were carried out with endoscopic assistance. The endoscope was used in three cases for anatomical orientation ‘around the corner’ only. Techniques and equipment vary depending on surgical aims, surgical anatomy and working area. Tips and pitfalls are identified and described.

Conclusions

Endoscopy can be applied safely in CPA pathologies, as an alternative to the operating microscope for highly selected cases, or as an adjunct for specific surgical steps, especially when microscope optics do not allow angled visualisation. It is particularly useful in identifying lesion residuum and ‘working around the corner’. High level training is required before applying endoscopy to the CPA.
P42 Predicting bleeding risk during meningioma surgery
Authors: Tsyben A , Surour M , Budohoski K , Kirollos R , Helmy A
Published: February 2019

Objectives

Surgical treatment of meningioma is frequently accompanied by significant intraoperative blood loss and the associated risks of blood transfusion. Surgical adjuncts such as pre-operative embolisation and the use of tranexamic acid have attendant risks. An ability to estimate blood loss can appropriately target these interventions.

Design

Retrospective study

Subjects

Patients following surgery for meningioma between 2015–2018

Methods

Intraoperative blood loss, pre- to post-operative haemoglobin difference and blood transfusion were evaluated. Pre-operative imaging included size, shape and location of meningioma, involvement of sinuses and blood vessels, T1 and T2 weighted characteristics, restricted diffusion, peritumoral oedema, dural tail and hyperostosis. Multivariate analysis was used to determine the relationship between meningioma characteristics and blood loss.

Results

Tumour diameter and venous sinus opening were significantly related to blood loss on multivariate analysis (p=0.004 and p=0.001 respectively). Furthermore, on univariate analysis additional factors included procedure duration (p<0.0001), pre-operative radiotherapy (p=0.042) and pre-operative platelet count (p=0.03).

Conclusions

Only size of tumour and opening venous sinuses was related to intraoperative bloods loss in this cohort of patients. Further research is required to define tumour characteristics that can be used to identify patients suitable for pre- and intra-operative adjunct therapies.
P44 Is restoration of pituitary function a realistic goal in endoscopic pituitary surgery?
Authors: Galloway L , Hayhurst C
Published: February 2019

Objectives

The ability to restore pituitary function after endoscopic transsphenoidal surgery (ETSS) in pituitary tumours causing hypopituitarism remains unclear. This study analyses patients that required steroid replacement therapy prior to ETSS, and reviews endocrine function postoperatively.

Methods

A prospectively held pituitary database was retrospectively analysed from May 2011 – July 2017 at a tertiary university hospital. Patients requiring steroids for hypopituitarism pre-operatively were included. Patient demographic data, tumour characteristics, and tumour hormonal profile were recorded.

Results

From a database of 156 patients, 28 (18%) were hypoadrenal pre-operatively and were included in the study. All patients underwent ETSS by a single neurosurgeon. The median age of patients was 56 years (range 17–81), whilst median follow-up was 48 months (range 6–78). 20 male patients and 8 female patients were included. All patients were established on steroid therapy preoperatively with either hydrocortisone (26 patients) or prednisolone (2 patients). 5 (18%) patients were able to stop steroid replacement postoperatively. The median time to cessation of steroid therapy was 4 months (range 2–16 months).

Conclusions

Restoration of pituitary function following ETSS surgery was only successful in a small number of patients despite meticulous gland preservation. Our results suggest that restoration of function in all patients undergoing ETSS is an unrealistic goal and patients should be counselled accordingly.
P45 Gamma knife radiosurgery for the primary management of acromegaly
Authors: Sims-Williams H , Rajapaksa K , Sinha S , Radatz M , Walton L , Yianni J , Newell-Price J
Published: February 2019

Objectives

Report outcome and morbidity data for the treatment of acromegaly with primary stereotactic radiosurgery (STRS).

Design

Retrospective.

Subjects

20 patients with acromegaly who underwent primary STRS at the National Centre for Radiosurgery, Sheffield (UK) between 1985 and 2015.

Methods

Review of notes, database, laboratory results, patient questionnaire and death certification. Guideline-based control was defined as normal age-sex-adjusted IGF1 levels and either random GH <1 µg/L or GH <0.3 µg/L (OGTT) or mean Growth Hormone Day Curve (GHDC) <1 µg/L.

Results

Control at 20 years was 100% and 75% on and off medication respectively. Median time to control on medication was 3 years and 7.4 years off medication. Median marginal radiation dose was 27.5 Gray and median follow-up was 167 months. Seven patients died, median age 65 years. There were no STRS-related deaths. 53% of patients developed new hypopituitarism at median follow-up of 146 months. First onset of hypopituitarism occurred up to 20 years after treatment. No other complications were noted. Three patients underwent trans-sphenoidal surgery due to poor biochemical control at a mean of 35 months.

Conclusions

Morbidity from STRS is low. There is significant latency to biochemical control and new onset hypopituitarism. While primary surgical intervention remains the gold standard in acromegaly, primary STRS results should inform discussions with patients considering non-surgical management.
P50 The role of care of the elderly in neurosurgery
Authors: Awan M , Bhagawati D
Published: February 2019

Objectives

Assess the volume of frailty in a neurosurgical centre and role of geriatric liaison.

Design

Retrospective Review.

Subjects

All patients admitted to Charing Cross Hospital in Jan 2018.

Methods

We reviewed patient notes to assess frailty score using the Clinical Frailty Scale (Dalhousie University) and differences with emergency vs elective admissions and length of stay (LoS).

Results

More than 50% of patients admitted to the unit were above 65 years old. 30% of all admissions met the criteria for mild to moderate frailty moreover 34% were classed as severely frail. These findings are comparable to acute medical wards. Two third of patients had an average LoS above 10 days, of these 50% were severely frail. Emergency admissions demonstrated a greater burden of frailty and expectedly LoS in severely frail patients was significantly higher 15 vs 40 days in elective and emergency admissions.

Conclusions

Neurosurgery units would benefit from a geriatric liaison service given the burden of frailty is equivalent to medical wards in-order to improve patient care, experience, turnover and LoS.
P54 Formative test questions in neurology and neurosurgery
Authors: Tallantyre EC , Corns R , Smith PE , Thomson S
Published: February 2019

Objectives

To provide a formative educational test of knowledge that allows clinicians to measure themselves against their peers.

Design

Annual Neurosurgery and Neurology knowledge tests, supported by the ABN & SBNS, have been available since 2014 (NSurg) and 2017 (Neurol). The NSurg test requires all candidates to participate over 3 days, answers are available after the test whereas the Neurol formative questions are available over 6 weeks, answers are available immediately.

Subjects

There have been 821 first attempts at the formative questions; NSurg; 44, 63,187,143,164 and Neurol; 74, 146. Candidates are mostly from UK (NSurg 92%, Neurol 69%) and mostly specialty trainees (NSurg 98%, Neurol 63%).

Methods

The formative questions are delivered through the ebrain virtual learning platform, statistics are generated automatically. Proposed questions are written by candidates as ‘payment’ for doing the formative test.

Results

Mean Cronbach’s alpha was 87.3%. The mean score for the tests was 60.4% (Range 55.9%–77.9%). Feedback is voluntary: In 2018 17 feedback comments were received, 10 were unambiguously positive, 5 were mixed including criticism of one or more questions, 2 were judged to be neutral. Examples of feedback comments received this year included ‘Comprehensive exam that covers a wide range of topics’ and ‘This is of great value’.

Conclusions

This formative educational initiative has high internal consistency and solid feedback. Although set up differently, it is proving both valuable and popular in both specialties.
P57 An innovative approach to workplace based didactic teaching in neurosurgery: initial experience
Authors: Kumaria A , Lucas EK , Chernykh V , Macarthur DC , Howarth SPS , Robertson IJA
Published: February 2019

Objectives

To increase the amount and quality of didactic teaching by commissioning an in-house Diploma course using distance-learning methodologies to supplement regular departmental teaching sessions.

Design

Web-based course consisting of 9 modules covering the breadth of neurosurgical topics. A Diploma was conferred by the Head of Service upon successful completion of all modules.

Subjects

To date, eleven learners (junior doctors at F1/F2/SHO level) have started the Diploma, including doctors from outside our department.

Methods

Learners download a module, dedicate a period of self-study and then discuss the module with their Tutor. To complete a module, a learner would be expected to demonstrate to the Tutor that their knowledge was at ST2 standard as described in the neurosurgical curriculum. Assessment of modules was documented on learners’ existing portfolios.

Results

By way of feedback, all learners (100%) strongly agreed that the Diploma was useful for their day to day job, that it helped understand management of acute neurosurgical problems, that it was interesting, that they would recommend it to a friend/colleague and that support received from the Course Tutor was helpful.

Conclusions

Learners reportedly enjoyed the self-directed, flexible aspect of the Diploma and found that it promoted interactive discussions with registrars and consultants. Feedback obtained externally through HEE and GMC was highly praiseworthy of the Diploma. We intend to continue to offer this course.
P63 Botulinum toxin a for post craniotomy head pain: a single centre case series of 11 patients
Authors: Lavin T
Published: February 2019

Objectives

Botulinum Toxin for post craniotomy head pain is not an established therapy. One small case series commented that it was effective in 3 patients.1We report our single centre experience.

Design

We performed a retrospective review of case notes of all patients treated with Botox for persistent post craniotomy or craniotomy head pain at Greater Manchester Neurosciences Centre, UK. All patients treated with Botulinum Toxin from 2014 at Greater Manchester Neurosciences Centre are listed on a central database, irrespective of indication. From the database 11 patients were identified who had received Botulinum Toxin A for post craniotomy scalp pain.

Subjects

Eleven (n=11) patients were identified. The mean age was 43 year. Of the 11 patients; 6 were women and 5 were men. The majority of patients underwent surgery for medically intractable epilepsy (n=7).

Methods

Information obtained: -Demographics -Date, indication and type of initial cranial neurosurgery Headache Characteristics (site, descriptors, duration, frequency) -Previous medical therapy -The presence of Epileptic Seizures -Frequency, dose and site of Botulinum Toxin injection -Response.

Results

A majority of patients (10/11) reported improvement in headache burden with 6 patients reported being pain free with no further daily headache. The duration of this effect varied from 4 to 12 weeks. No specific headache characteristic (site, descriptor) predicted a favourable response. Of the remaining 5 who continue to report daily head pain, 4 felt the burden was more manageable. One patient felt there was no response. Of the 5 patients with persistent headaches, 3 were chronic epileptics with ongoing seizures, compared to only 1 patient in the responder group.

Conclusions

This case series is limited by small numbers and no objective headaches made prior or post therapy. Botulinum Toxin A appears to have a beneficial effect in the management of chronic post craniotomy head pain within this small sample with complete abolition of pain in 55%. The presence of ongoing epileptic seizures may indicate a poor response. Further controlled studies are warranted.
P72 Riluzole causing pancytopenia: a clinically important rarity
Authors: Islam M
Published: February 2019

Design

Case Report: An 83-year-old lady, was admitted with progressive speech and swallowing difficulty and wasting of small muscles of hand for 3 months. EMG revealed widespread anterior horn cell disease. With a diagnosis of MND, She was started on Riluzole 50 mg, LFT and FBC were normal before and 2 days after 1 st dose and the dose increased to a recommended dose of 50 mg twice a day. While waiting for PEG tube insertion, within 7 days, FBC showed a significant drop in Hb of 23 g/L ( from 125 to 102 g/L), Platelet dropped to 150×x10^9/L from 208 × 10^9/L, leucopenica ( 2.4 × 10^9/L) without any significant neutropenia. Her follow up haemogram showed persistent pancytopenia with more evident leucopenia and thrombocytopenia over next 7 days. She had no symptoms and signs of infection with normal infection screen. Her medication history was unremarkable apart from riluzole and thyroxine. No past history of liver disease or haematological conditions. Serum electrophoresis, Vitamin B12 and Folate were completely normal. A diagnosis of riluzole induced pancytopenia was made. A study by FDA suggests out of 861 patients, 3 patients (0.35%) developed Pancytopenia and 100% of them had it in the 1 st month. The aim of this case report to highlight the importance of considering Pancytopenia as an adverse reaction of riluzole. Patient may develop overt sepsis as a part of the spectrum. In that case, risk and benefit of riluzole prescription needs to addressed as an individual case basis.
P74 Cervical disc arthroplasty employing a novel compressible prosthesis: a single arm observational study of 101 patients
Authors: Prezerakos G , Cat DA , D’Antona L , Allibone J , Casey A
Published: February 2019

Objectives

The study aims to evaluate the radiological, clinical efficacy and safety of a novel compressible cervical disc prosthesis in the treatment of degenerative cervical radiculopathy

Design

Observational non-randomised case series based in two centres.

Subjects

101 consecutive patients (137 artificial discs) treated for cervical radiculopathy secondary to cervical disc degeneration. Mean age at operation 45.4 years.

Methods

Neck Disability Index, Visual Analogue Score for neck and arm pain, Euro Quality of Life −5D survey, index level range of movement, heterotopic ossification, adjacent level disease, re-intervention rate and safety profile were assessed. Clinical (outpatient and telephone questionnaires) and radiological (Nuvaline and McKeeson PACS suites) were employed

Results

Index range of movement was 7.9 degrees pre operatively and 7.6 at two years. 2 re operations at supradjacent levels took place post treatment in a 35 month follow-up period. 1 post-operative haematoma and 1 delayed infection occurred. All four primary outcome measures exhibited significant improvement from baseline to last follow up; NDI (47.5 to 24.9, p<0.001) EURO QOL index (0.36 to 0.84, p<0.0001) and VAS Arm (5.6 to 0.85 p<0.0001) and VAS Neck (7.1 to 1.7, p<0.0001).

Conclusions

The compressible disc prosthesis preserved 96.2% of the initial range of movement at index level whilst exhibiting a favourable re operation rate and safety profile.
P75 Factors that predict degree of spinal cord compression and optimal spinal cord perfusion pressure in patients with acute, severe traumatic spinal cord injuries
Authors: Hogg FRA , Gallagher MJ , Chen S , Zoumprouli A , Saadoun S , Papadopoulos M
Published: February 2019

Objectives

To identify factors which predict intra-spinal pressure (ISP) and optimal spinal cord perfusion pressure (SCPPopt) in patients with acute, severe traumatic spinal cord injuries (TSCI) that could be used instead of invasive ISP monitoring.

Methods

We monitored ISP, mean arterial pressure (MAP) and computed spinal cord perfusion pressure (SCPP), spinal pressure reactivity index (sPRx) and SCPPopt in 64 TSCI patients, AIS grades A–C who were part of the Injured Spinal Cord Pressure Evaluation (ISCoPE) study. We recorded baseline, injury/imaging and management variables which may influence ISP/SCPPopt. Statistical analysis was used to investigate differences in ISP/SCPPopt between the variables

Results

51% (34/64) had U-shaped sPRx vs. SCPP curve in the first 24 hours after surgery. Mean SCPPopt was 74 mmHg (range 48–103). Lower mean 24 hour ISP was found with: older age, alcohol excess, non-conus medullaris injury, duroplasty and less surgical bleeding. Mean ISP on day 1 after surgery correlates with mean ISP over the first week. Lower 24 hour SCPPopt was associated with: higher mean ISP and conus medullaris injury. No MRI factors predicted ISP or SCPPopt.

Conclusions

Several factors predict ISP. Modifiable factors to reduce ISP are less surgical bleeding and expansion duroplasty. No variables predict SCPPopt. ISP monitoring remains the only way to estimate SCPPopt to help prevent secondary damage and we continue to support use of ISP monitoring to individualise management in acute, severe TSCI.
P76 Skip laminectomy versus cervical laminectomy, an analysis of patient reported outcomes, spinal alignment and re-operation rates: the leeds spinal unit experience (2008–2016)
Authors: Robins JMW , Luo L , Mallallah F , Timothy J , Pal D , Derham C , Selvanathan SK
Published: February 2019

Objectives

To compare clinical, radiological and complication results between skip laminectomy and cervical laminectomy for posterior cervical decompression for cervical spondylotic myelopathy.

Design

Retrospective single institution cohort study.

Subjects

Subjects underwent primary skip or cervical laminectomy between 2008–2016.

Methods

Statistical analysis compared pre- and post-operative differences in Visual Analogue Scale, Neck Disability Index and radiological differences in sagittal alignment of the vertebral bodies. Analysis of re-operation rates was performed.

Results

A total of 42 and 29 patients had skip and cervical laminectomy respectively. Median follow up was 32±23.1 (Range: 1–325) weeks. Post-operatively there was no difference in patient reported outcomes namely Visual Analogue Scale and Neck Disability Index between skip laminectomy and cervical laminectomy groups compared to pre-operatively (p=0.64, p=0.75). No difference was seen in sagittal alignment between both groups following surgery (p=0.65). Three patients (7.1%) in the skip laminectomy group and two patients (6.9%) in the cervical laminectomy group required revision surgery to the cervical spinal region at a different level to the original surgery. No patients needed further instrumentation.

Conclusions

Both skip laminectomy and cervical laminectomy appear to deliver similar outcomes with regards to patient reported outcomes, preserving sagittal alignment and re-operation rates over this short follow-up period.
P77 Type II PEG fractures: collar or no collar
Authors: Harris L , Arif S , Brady Z , Elliot M , Lee CH , Tsang KT
Published: February 2019

Objectives

Type 2 peg fractures are known to have low fusion rates but most are elderly with comorbidities and not fit for surgery. Increasingly, clinicians want to stop using hard collars due to its complications, but with little supporting evidence. We aim to provide data to add to this debate.

Design

Single centre cohort study.

Subjects

145 consecutive patients referred to a Major Trauma Centre as type 2 peg fracture.

Methods

All patients referred with a suspected peg fracture between March 2015 and December 2017 were included. All imaging were assessed and case notes reviewed for patient demographics, fracture management, complications and outcomes.

Results

102 cases were peg fractures (mean age=80 years). 92 (90.2%) were managed conservatively with a hard collar (mean of 87 days). 37% developed symptoms from the collar, namely pain, stiffness and non-tolerance. Bony union was achieved in only 39.1% of patients with increasing age being an independent risk factor (p<0.001). Of the 56 patients who did not have bony union, there were no reported symptoms and 90% were discharged without a collar. 2 patients were offered but declined fixation and neither reported any on-going symptoms.

Conclusions

This study adds to the body of evidence that fusion rates are low, and collar complications are not insignificant when type 2 peg fractures are treated in a hard collar. However, outcomes are good regardless of union, potentially rendering the collar unnecessary. We aim to conduct a randomised prospective study to further investigate.
P78 Recovery priorities for patients with degenerative cervical myelopathy
Authors: Davies Benjamin M , Mowforth Oliver D , Sadler Iwan , Aarabi Bizhan , Kwon Brian K , Kurpad Shekar N , Harrop James , Wilson Jefferson R , Grossman Robert , Fehlings Michael G , Kotter Mark RN
Published: February 2019

Objectives

The misalignment of patient and researcher objectives has been shown to contribute to research inefficiency and wastage. The patient research priorities in degenerative cervical myelopathy [DCM] are unknown. The present study aimed to establish relevant functional domains and their recovery priority to DCM sufferers.

Design

Functional domains were established from qualitative patient interviews (n=4), and the recovery priority through an e-survey (n=659).

Subjects

DCM Patients recruited via a DCM charity [Myelopathy.org] and Google Adwords.

Methods

Seven functional domains were identified: arm and hand, walking, upper body/trunk, sexual, elimination of pain, normal sensation and bladder/bowel function. Patients were asked to rank these domains. The influence of disease characteristics on selection was analysed.

Results

481 complete responses were analysed. Overall, pain was the most popular recovery priority (39.9%), followed by walking (20.2%), sensation (11.9) and arm and hand function (11.5%). Sexual function (5.7%), bladder and bowel (3.7%) or trunk function (3.5%) were chosen less frequently. With respect to disease characteristics, overall pain remained the recovery priority [with the exception of patients with greater walking impairment (p<0.005) who prioritised walking] even amongst patients with lower pain scores.

Conclusions

Pain is a recovery priority for DCM patients, even amongst those reporting low levels of pain.
P79 Is length of stay (LOS) equivalent for elective anterior cervical discectomy (ACD) patients in an NHS hospital and as waiting list initiative cases in a private hospital?
Authors: Meacock J , Thomson S , Derham C
Published: February 2019

Objectives

To investigate if there is a significant difference between the LOS for patients admitted as waiting list initiative patients to a private hospital versus standard care in an NHS hospital.

Design

Retrospective analysis between 2015 and 2017 of all ACD procedures at the two hospitals.

Subjects

674 elective NHS patients were included, 340 were admitted to the NHS hospital and 334 as waiting list initiative patients to the private hospital. Acute patients were excluded.

Methods

Retrospective database search of electronic hospital records for all ACD procedures carried out between 2015 and 2017. The student standard t test analysis was used to compare the difference in LOS.

Results

In both groups 100% were admitted on the day of surgery. The mean NHS LOS was 3.3 (SD=6.34) days and the private hospital was 1.1 (SD=0.97) days. (p<0.001) For the patients admitted to the private hospital 96% of the patients went home with 1 night stay, only 61% of the patients went home in the same period in the NHS hospital.

Conclusions

We found that length of stay is significantly shorter in the private hospital than in the NHS hospital. This could be due to patient selection, a swifter patient pathway or a combination of the two and these factors will be explored.
P82 Pelvic neurophysiological and urodynamics findings in patients with sacral-level tarlov cysts
Authors: Simeoni S , Malladi P , Pakzad M , Casey A , Panicker J
Published: February 2019

Objectives

Sacral Tarlov cysts (TC) are frequent incidental findings on spinal MRI. Controversy remains regarding their ability to cause nerve root compression. Pelvic neurophysiological and urodynamics testing provides information about sacral nerve root involvement.

Design

Case series

Subjects

Patients with MRI evidence of sacral (S1, 2 or 3) TC seen in the Uro-neurology Department between 2011 and 2018.

Methods

Clinical, neurophysiological and urodynamics data were reviewed.

Results

13 patients (9 females, mean age54/SD13.1) were included. Symptoms were urgency/incontinence (n=8), hesitancy/urinary retention (n=7), bowel complaints (n=4), sexual complaints (n=3), back pain (n=5), genital/pelvic pain (n=6), genital numbness (n=5), impaired sensation of bladder fullness (n=2), lower limb (LL) pain/hypoesthesia (n=6), LL weakness (n=2). The following neurophysiological abnormalities were seen: anal sphincter EMG (n=10) evidence for reinnervation (n=8), pudendal sensory evoked potentials (SEPs) (n=6) absent response (n=1), S2 and S3 dermatomal SEPs (n=6) absent response (n=2), sympathetic skin response (n=6) absent response (n=3). Findings in cystometry (n=5) were: detrusor underactivity (n=2), detrusor after-contraction (n=1), equivocal obstructed voiding (n=1) and reduced bladder compliance (n=1).

Conclusions

Abnormal results in urodynamics and pelvic neurophysiology suggest involvement of the somatic and autonomic sacral innervation. Further studies are required to explore any association between structural changes on MRI and functional changes in urodynamics and neurophysiology.
P85 Waiting time for operative management of degenerative cervical myelopathy (DCM) and its impact on outcome
Authors: Lawrence PL
Published: February 2019

Objectives

To audit the waiting time for patients with degenerative cervical myelopathy (DCM ) and its impact on outcome in the Imperial College NHS Trust (ICNHST) against the latest AO standard.

Design

Retrospective analysis.

Subjects

1. Waiting time for surgery and impact on outcome for DCM. 2. Operative approach.

Methods

The medical records of 107 patients who had undergone surgery for DCM at ICNHST in 2016 to 2017 was reviewed. Central tendency analysis of nominal and ordinal variables such as surgery waiting time and demographics were assessed using Microsoft excel.

Results

The mean age reviewed was 58.2 years. Male to female ratio was 1:1. The mean wait time was 10.22 overall. However, 58% of cases were moderate with mean wait time in that stratum at 4 weeks. Most patients improved at 3–6 months by 2 points on the mJOA regardless of approach done although 63% of cases were anterior. The results were compatible with the latest AO recommendations except for mild patients where it seemed more efficient to converse about morbidity of surgery vs myelopathy in the first instance, since disease burden is tolerable and plated in most hence risk may outweigh benefit. The approach chosen should be individually chosen based on a gestalt of patient and disease factors since results are equivocal.

Conclusions

The approach to the cervical myelopathy must be taken at the merit of each patient based on a gestalt of the individual clinical factors involved. However, default approach to limiting wait to under 4 weeks is reasonable.
P87 Spinal fractures incurred by a fall from standing height
Authors: Hall S , Myers M , Sadek A , Baxter M , Dare C , Griffith C , Shenouda E , Nader-Sepahi A
Published: February 2019

Objectives

Falls from standing are an important cause of vertebral fractures, particularly in the elderly. They are associated with significant morbidity and long-term mortality. The aim of this study was to determine the treatment and outcomes, in a single centre, of managing spinal fractures due to falls from standing height.

Design

Retrospective case note review of patients with a fracture sustained due to a fall from standing (2011–2016 inclusive).

Subjects

229 patients with average age 76.6±14.5 years; 134 (58.5%) female.

Methods

Patients were identified from the Trauma Audit and Research Network database. Case notes were reviewed for demographics, treatment details and outcome at 6 months post-admission.

Results

1408 patients were admitted with spinal fractures of which 229 (16.3%) sustained a fall from standing height. Two hundred and eighty-three fractures were identified in the 229 patients, which were distributed in the cervical (n=140), thoracic (n=65) and lumbar (n=78) spine. The average ISS score was 9.7±5.4. Twenty-three (10.0%) patients had either incomplete or complete spinal cord injury. Fifty-six (24.5%) patients underwent surgical intervention. Forty-three patients (18.7%) died within 6 months and increasing age and Charlson co-morbidity score were associated with higher mortality.

Conclusions

Falls from standing comprise a large portion of the spinal service emergency workload. They are associated with a high 6 month mortality similar to other fragility fractures experienced by the elderly.
P88 Identifying risk factors for multiple revisional lumbar spine surgery
Authors: El Sheikh M , Badran K , Kouli O , Abdelsadg M , Fadelalla M , Hossain-Ibrahim K
Published: February 2019

Objectives

Recurrent lumbar spine surgery due to disc herniation is a contributor to debilitating pain, disability, and carries a high patient morbidity rate1We identified risk factors for recurrent lumbar disc herniation post-surgical intervention.

Design

Retrospective Cohort Study.

Subjects

All adult lumbar spine revisions for disc herniation performed in the Neurosurgical Department at Ninewells Hospital.

Methods

The number of revisions from 2013 to 2017 for each patient was recorded and two groups were identified. The first group consisted of patients who had one revision and the second group consisted of patients who had recurrent revisions (more than one) Possible factors influencing the likelihood of recurrent revisions were also noted, including age, gender, BMI, operation length, level of surgery, time from primary surgery to revision, smoking and diabetes status.

Results

140 patients had revision surgeries, of which 87 (62.1%) had one revision while 53 (37.1%) had recurrent operations. Younger patients (p=0.025) and patients with higher BMI (p=0.01) were more likely to have a higher number of revisions. Patients with DM (p=0.015) were associated with a higher likelihood of recurrent revisions. Other factors had little effect on the likelihood of recurrent revisions (p>0.05).

Conclusions

Identifying risk factors that influence the recurrence of lumbar revisions helps improve patient outcome and decrease incidence of revisions.
P89 Spinal disease in neurofibromatosis type 1 (NF1): a systematic review to evaluate reported patterns of pathology
Authors: Mohan M , Waqar M , George KJ
Published: February 2019

Objectives

To describe the characteristics of reported spinal pathology in NF1 patients.

Design

Systematic review.

Subjects

1809 patients from 23 studies.

Methods

This review was conducted as per PRISMA guidelines and registered on the PROSPERO database of systematic reviews. Systematic searches were performed on the following databases: PubMed, PsycINFO, Medline, HMIC, HBE, EMBASE, CINAHL, BNI, AMED and the Cochrane Database of Systematic Reviews. Studies with n>1 describing any spinal abnormality in NF1 patients were included.

Results

23 studies were included from 1253 unique results. The evidence levels were as follows: I (n=1), II (n=2) and IV (n=19). Data was available in 1809 patients with a mean age of 22.5 years and equal gender distribution (49.3% male). Reported spinal pathology included: dural ectasia – 93/290 (32.1%); scoliosis – 326/748 (43.6%); meningocele – 5/31 (16.1%); syrinx – 10/97 (10%); cord signal abnormalities in the absence of tumour compression – 33/97 (34%); intramedullary tumour – 7/82 (8.5%); spinal nerve root tumour – 276/1350 (20.4%); and spinal plexiform tumour – 167/364 (45.9%). Degenerative spinal disease and Chiari malformation were not described to any meaningful extent.

Conclusions

Spinal pathology is common in patients with NF1 though existing literature is heterogeneous in how findings are presented. Most existing studies are of low quality. There is a need for prospective studies on this theme to aid the establishment of a core outcome set for spinal disease in NF1 patients.
P90 A systematic review of spinal cord serum and cerebrospinal fluid biomarkers for use in degenerative cervical myelopathy
Authors: Stewart M , Smith S , Davies B , Hutchinson P , Kotter M
Published: February 2019

Objectives

Whilst radiological evidence of compression is the hallmark of degenerative cervical myelopathy [DCM], it is unable to stage or prognosticate. Moreover, asymptomatic spinal cord compression is common and therefore new methods of assessing spinal cord function are required. We aimed to: 1) Evaluate the evidence-base for serum and CSF biomarkers of spinal cord damage in diagnosis, prognosis or predicting response to treatment in DCM 2) Identify serum and CSF biomarkers of spinal cord damage studied in other conditions, which may have relevance to DCM.

Design

Scoping review.

Subjects

Human only.

Methods

A search of MEDLINE and EMBASE was performed. Studies involving DCM patients or biomarkers relevant to spinal cord pathobiology were included.

Results

852 results were screened, of which 83 were included. 9 studies explored 12 biomarkers in DCM. NFH (n=3), S100b and NSE (n=2) received most study. 74 studies explored a further 118 biomarkers in other conditions; S100b (n=13), NFH (n=11) and GFAP (n=10) received most study. Overall, 72 studies used targeted approaches, in which candidate biomarkers were chosen in advance. 11 used unbiased approaches, in which high throughput analyses identified candidate biomarkers during the study.

Conclusions

The evidence-base for use of biomarkers in DCM is limited. Whilst targeted approaches have identified a number of candidate spinal cord markers, few have shown clinical utility. There is a shift towards investigating panels of multiple markers and unbiased, high-throughput approaches.
P94 Ventricular subgaleal shunting is a safe and effective temporising measure for the treatment of neonatal post haemorrhagic hydrocephalus
Authors: Dawes WJ , James G , Aquilina K
Published: February 2019

Objectives

The use of a temporising device to facilitate neonatal maturation prior to permanent ventricular peritoneal shunt (VPS) remains gold standard treatment for neonatal posthaemorrhagic hydrocephalus (PHH). The relative superiority of ventricular access device (VAD) or ventricular subgaleal shunt (VSG) remains contentious.

Design

Retrospective case note review.

Subjects

49 neonates born between Sept 2012 to April 2018: (M:F 34:15); Average: gestation 26+3 (23 to 32+5); birth weight 870 g (±355 g); Papile grade 3:4 (ratio ≈ 1:2).

Methods

Computer records from neonatal VSG at a single tertiary care children’s hospital reviewed.

Results

Early complications associated with VSG seen in 13 cases (27%). Migration of shunt n=3, infection n=2, inadequate control of ventricular volume n=5, decompression haemorrhage n=2, wound leak n=1. All patients managed on NICU with an average inpatient stay of 5 days (range 2 to 15). 5 outcome groups defined: 1. Patient died (non neurological cause) (n=4) 2. VSGin situfor <1 year (n=7) 3. VSG and no VPS (n=6 16%) 4. VSG and VPS X1 never revised (n=17 45%) 5. VSG and VPS with revisions (n=15 39%) Rate of shunting in patients with VSG >1 year=84%. All patients that needed permanent VPS were operated within the first year. The average time elapsed prior to VPS was 86 days with over 80% of cases shunted within 100 days.

Conclusions

VSG remains a safe method of temporary CSF drainage for the treatment of neonatal PHH with rates of shunting in line with the published literature.
P96 Screening for cerebrovascular pathology on the basis of positive family history in the paediatric population
Authors: Millward CP , Tonder LV , Foster M , Williams D , Griffiths M , Kneen R , Sinha A , Mallucci C
Published: February 2019

Objectives

Neurovascular disorders are uncommon, complex conditions in children. We reviewed the screening practice and outcome of children referred to the neurovascular service on the basis of positive family history.

Design

Retrospective review of prospectively maintained database.

Subjects

Children referred to the neurovascular service on the basis of family history, for screening at our hospital.

Methods

We retrospectively examined our database between July 2008 and April 2018 for the reasons for referral, family history, investigations performed, and the outcome of the screening process.

Results

44 children were reviewed (23 male, median age 10). Thirty-one children had an MRI/MRA brain. One child subsequently had uncomplicated digital subtraction angiography. Thirty children were referred due to a family history of subarachnoid haemorrhage, of which 17 had a single first-degree relative, and two had two first-degree relatives. Nine children were referred with a family history of arteriovenous malformation, (2 were associated with hereditary haemorrhagic telangiectasia). Five children were discussed due to a family history of non-specific haemorrhagic stroke. Seven children had a history of headache, (4 were prescribed Pizotifen for migraine). No neurovascular pathology was detected following screening within our cohort.

Conclusions

A consensus screening policy does not exist but is required both to guide clinical practice and to assuage parental or patient concerns. We will survey UK paediatric centres to commence this process.