bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

ObjectivesTo 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.DesignWeb-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.SubjectsTo date, eleven learners (junior doctors at F1/F2/SHO level) have started the Diploma, including doctors from outside our department.MethodsLearners 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.ResultsBy 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.ConclusionsLearners 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

ObjectivesBotulinum 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.DesignWe 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.SubjectsEleven (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).MethodsInformation 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.ResultsA 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.ConclusionsThis 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

DesignCase 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

ObjectivesThe study aims to evaluate the radiological, clinical efficacy and safety of a novel compressible cervical disc prosthesis in the treatment of degenerative cervical radiculopathyDesignObservational non-randomised case series based in two centres.Subjects101 consecutive patients (137 artificial discs) treated for cervical radiculopathy secondary to cervical disc degeneration. Mean age at operation 45.4 years.MethodsNeck 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 employedResultsIndex 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).ConclusionsThe 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

ObjectivesTo 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.MethodsWe 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 variablesResults51% (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.ConclusionsSeveral 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

ObjectivesTo compare clinical, radiological and complication results between skip laminectomy and cervical laminectomy for posterior cervical decompression for cervical spondylotic myelopathy.DesignRetrospective single institution cohort study.SubjectsSubjects underwent primary skip or cervical laminectomy between 2008–2016.MethodsStatistical 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.ResultsA 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.ConclusionsBoth 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

ObjectivesType 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.DesignSingle centre cohort study.Subjects145 consecutive patients referred to a Major Trauma Centre as type 2 peg fracture.MethodsAll 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.Results102 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.ConclusionsThis 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

ObjectivesThe 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.DesignFunctional domains were established from qualitative patient interviews (n=4), and the recovery priority through an e-survey (n=659).SubjectsDCM Patients recruited via a DCM charity [Myelopathy.org] and Google Adwords.MethodsSeven 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.Results481 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.ConclusionsPain 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

ObjectivesTo 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.DesignRetrospective analysis between 2015 and 2017 of all ACD procedures at the two hospitals.Subjects674 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.MethodsRetrospective 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.ResultsIn 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.ConclusionsWe 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

ObjectivesSacral 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.DesignCase seriesSubjectsPatients with MRI evidence of sacral (S1, 2 or 3) TC seen in the Uro-neurology Department between 2011 and 2018.MethodsClinical, neurophysiological and urodynamics data were reviewed.Results13 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).ConclusionsAbnormal 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

ObjectivesTo 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.DesignRetrospective analysis.Subjects1. Waiting time for surgery and impact on outcome for DCM. 2. Operative approach.MethodsThe 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.ResultsThe 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.ConclusionsThe 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

ObjectivesFalls 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.DesignRetrospective case note review of patients with a fracture sustained due to a fall from standing (2011–2016 inclusive).Subjects229 patients with average age 76.6±14.5 years; 134 (58.5%) female.MethodsPatients 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.Results1408 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.ConclusionsFalls 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

ObjectivesRecurrent 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.DesignRetrospective Cohort Study.SubjectsAll adult lumbar spine revisions for disc herniation performed in the Neurosurgical Department at Ninewells Hospital.MethodsThe 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.Results140 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).ConclusionsIdentifying 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

ObjectivesTo describe the characteristics of reported spinal pathology in NF1 patients.DesignSystematic review.Subjects1809 patients from 23 studies.MethodsThis 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.Results23 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.ConclusionsSpinal 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.