Cauda equina syndrome.

Aims: Patients with cauda equina syndrome (CES) require emergency imaging and surgical decompression. The severity and type of symptoms may influence the timing of imaging and surgery, and help predict the patient's prognosis. Categories of CES attempt to group patients for management and prognostication purposes.

Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: A multi-centre prospective cohort study.

Background: Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures.

Methods: This is a prospective multi-centre observational cohort study of adults with CES in the UK.

Demographics of Cauda Equina Syndrome: A Population-Based Incidence Study.

Introduction: Cauda equina syndrome (CES) has significant medical, social, and legal consequences. Understanding the number of people presenting with CES and their demographic features is essential for planning healthcare services to ensure timely and appropriate management. We aimed to establish the incidence of CES in a single country and stratify incidence by age, gender, and socioeconomic status.

Assessment of the utility of the National Health Service England Low Back and Radicular Pain Pathway: analysis of patient reported outcomes.

Introduction: Lumbar disc herniation causing radiculopathy is a common reason for referral to spinal out-patient clinics. At our centre following routine referral, patients wait a mean of 109 weeks for a consultation with a spinal surgeon. A pathway in keeping with the National Health Service England Low Back and Radicular Pain Pathway was introduced with two objectives.

Advancing spinal fellowship training: an international multi-centre educational perspective.

Purpose: The purpose of this article is to review the importance of contemporary spine surgery fellowships and educational strategies to assist with fellowship design and delivery.

Methods: Spine surgery fellowship includes trainees from orthopaedic and neurosurgical backgrounds and is increasingly indicated for individuals wishing to pursue spine surgery as a career, recognizing how spinal surgery evolved significantly in scope and complexity. We combine expert opinion with a review of the literature and international experience to expound spine fellowship training.

Understanding cauda equina syndrome: protocol for a UK multicentre prospective observational cohort study.

Introduction: Cauda equina syndrome (CES) is a potentially devastating condition caused by compression of the cauda equina nerve roots. This can result in bowel, bladder and sexual dysfunction plus lower limb weakness, numbness and pain. CES occurs infrequently, but has serious potential morbidity and medicolegal consequences.

Recurrent injury patterns in adolescent rugby.

Objectives: To establish patterns of subsequent injury in U18 rugby, to quantify the burden of within season injury recurrence.

Design: Secondary analysis of prospective data.

Setting: 28 Schools in Ireland.

Influence of timing of surgery on Cauda equina syndrome: Outcomes at a national spinal centre.

Purpose: There is no doubt that the best outcome achieved in Cauda equina syndrome (CES) involves surgical decompression. The controversy regarding outcome lies with timing of surgery. This study reports outcomes on a large population based series.

Antisepsis of the skin before spinal surgery with povidone iodine-alcohol followed by chlorhexidine gluconate-alcohol povidone iodine-alcohol applied twice for the prevention of contamination of the wound by bacteria: a randomised controlled trial.

Aims: The aim of this study was to determine whether the sequential application of povidone iodine-alcohol (PVI) followed by chlorhexidine gluconate-alcohol (CHG) would reduce surgical wound contamination to a greater extent than PVI applied twice in patients undergoing spinal surgery.

Patients And Methods: A single-centre, interventional, two arm, parallel group randomised controlled trial was undertaken, involving 407 patients who underwent elective spinal surgery. For 203 patients, the skin was disinfected before surgery using PVI (10% [w/w (1% w/w available iodine)] in 95% industrial denatured alcohol, povidone iodine; Videne Alcoholic Tincture) twice, and for 204 patients using PVI once followed by CHG (2% [w/v] chlorhexidine gluconate in 70% [v/v] isopropyl alcohol; Chloraprep with tint).

Is it necessary to embolise all spinal metastases from primary renal tumours?

Introduction: Spinal metastases secondary to renal cell carcinoma are associated with significant intra-operative blood loss. Our aim was to assess if embolisation reduced the intra-operative blood loss and transfusion requirement.

Methods: We performed a retrospective cohort study of 25 patients undergoing surgery between 2003 and 2011.

Traumatic central cord syndrome: neurological and functional outcome at 3 years.

Study Design: Retrospective cohort analysis with prospective follow-up.

Objectives: To evaluate neurological and functional recovery following central cord syndrome.

Setting: Northern Ireland, population 1.

RISUS study: Rugby Injury Surveillance in Ulster Schools.

Objective: To examine injury patterns in adolescent rugby players and determine factors associated with injury risk.

Design: Prospective injury surveillance study.

Setting: N=28 Grammar Schools in Ulster, Ireland (2014-2015 playing season).

'Scan-negative' cauda equina syndrome: Evidence of functional disorder from a prospective case series.

In the first prospective comparison of 'scan-negative' (n=11) and 'scan-positive' (n=7) patients with cauda equina syndrome (CES) we found that Hoover's sign of functional leg weakness but not routine clinical features differentiated the two groups (p<0.02). This offers a new direction of study in this area, although magnetic resonance imaging is still required for all patients with possible CES.

Does formal education and training of staff reduce the operation rate for fractures of the distal radius?

Background: Fractures of the distal radius are one of the most common extremity fractures, and operation rates are increasing. Staff within our unit felt that formal teaching, particularly of new medical staff, with regards to fracture reduction and appropriate cast application could result in a reduction in operation rates.

Methods: Retrospective data was extracted from FORD (Fracture Outcome and Research Database), including: number of fractures, number of fractures undergoing ORIF, fracture configuration, patient demographics, and mechanism of injury.

Extensive cervical spine and foregut anomaly in 'serpentine syndrome'.

Introduction: We report an extremely rare and challenging combination of congenital anomalies. Only five similar cases have been described in the English language medical literature to date.

Presentation Of Case: A male infant was born at 30(+5) weeks gestation by emergency caesarian section.

Chordoma of the lumbar spine - a potential diagnosis not to be forgotten.

Chordoma is a rare, malignant neoplasm thought to develop from the notochord. It most commonly occurs in the base of the cranium or the sacro-coccygeal region but around 15-20% affect the vertebral body. Extra-lesional resection with or without adjuvant radiotherapy is generally accepted as the mainstay of treatment for this slow-growing tumour.