Safety in spinal surgery-Empowering clinicians to report concerns in motor function.

AIMS: Timely identification of neurological deterioration in patients with spinal disorders, through spinal motor assessment, is paramount in achieving early intervention to reduce the risk of permanent deficits. This project was initiated to meet the requirement for safe, timely spinal motor assessment through establishing and addressing clinician's educational needs. DESIGN: Mixed methods study conducted through online survey and concurrent focus groups June 2022-April 2023. METHODS: Pre-intervention online survey and focus groups identified insufficient provision of education targeted at identifying changes in motor function and as a result, clinicians lacked confidence and competence in completing assessments and caring for patients with spinal disorders. An e-learning package was created and shared widely along with additional interventions to support assessment completion. To establish the success of the project a post-intervention online survey was distributed. RESULTS: Survey respondents reported that the e-learning package has influenced their practice to either some extent or to a great extent with 91% reporting increased confidence in completing a spinal motor assessment. Post-intervention results also demonstrated an increase in confidence in caring for spinal surgery patients. CONCLUSION: Through engaging with clinicians to establish and address educational needs, this quality improvement project has successfully increased competence and confidence in this area of spinal care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This study highlights the importance of targeted education to ensure that clinicians are appropriately skilled to identify neurological deterioration and demonstrates the effectiveness of digital education in providing this. IMPACT: This study addressed concerns around timely identification of deterioration of spinal patients. Study findings were the success in utilizing digital education to increase clinician's confidence and competence and thus enhance patient safety. This research will have an impact on clinical areas caring for patients with spinal disorders. REPORTING METHOD: SQUIRE guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Clinical Anatomy of the Sacral Nerve Roots and Its Relevance to Their Reconstruction After Sacrectomy.

BACKGROUND AND OBJECTIVES: En bloc sacrectomy is associated with sacral root transection causing loss of urinary bladder, rectum, and sexual function. The aim of the study was to determine the position of the pudendal branches (sensorimotor) and pelvic splanchnic nerves (parasympathetic) on the sacral roots relative to the sacrum, and the minimal and maximal defects in the sacral roots that can be reconstructed by grafting after various types of sacrectomy. METHODS: Five cadaveric pelves were dissected bilaterally. The lengths and widths of the S1-S4 roots and their branches were measured. Then, the minimal and maximal defects between the proximal and distal stumps of the sacrificed roots were measured following 3 models of sacrectomy (below S2, below S1, and total sacrectomy). RESULTS: The mean distance of the splanchnic nerves from the S2 and S3 anterior sacral foramina was 17.7 ± 7.3 and 23.6 ± 11.1 mm, respectively, and the mean distance of the pudendal S2 and S3 branches was 36.8 ± 13.7 and 30.2 ± 10.8 mm, respectively. The mean widths of the S2 and S3 roots were 9.3 ± 1.9 and 5.4 ± 1.2 mm, respectively. The mean maximal defects in S2 and S3 roots after various types of sacrectomies were between 61.8 ± 16.3 and 100.7 ± 14.3 mm and between 62.7 ± 20.2 and 84.7 ± 25.1 mm, respectively. There were no statistically significant differences between sides or sexes for all obtained measurements. CONCLUSION: The reconstruction of the S2-S3 roots is anatomically feasible after partial or total sacrectomies in which the resection of the soft tissue does not extend further than approximately 1.5 to 2 cm ventrally from the sacrum.

Oxford Spine Buddies: an acceptability and feasibility project for peer-to-peer support in a spine sarcoma service.

BACKGROUND: Primary bone and soft tissue sarcoma of the spine are rare and account for less than 0.2% of all neoplasm incidences. Following a patient and public involvement event, the need to explore patient support pathways was identified, which initiated this service evaluation project. AIM: To determine the acceptability and feasibility of a peer-to-peer support project among people using the spine sarcoma service. METHODS: Users were paired and introduced via Microsoft Teams. Quantitative and qualitative data both pre- and post-introduction of a buddy were collected. FINDINGS: Service users felt that, although they would have preferred having a buddy at the time of their diagnosis, being allocated a buddy made them feel reassured and better supported. CONCLUSION: The project was well received and preliminary data are encouraging. Therefore, due to early findings from the first participants, the service is continuing to roll out the buddy programme.

Oxford Video Informed Consent Tool (OxVIC): a pilot study of informed video consent in spinal surgery and preoperative patient satisfaction.

OBJECTIVES: The British Association of Spinal Surgeons recently called for updates in consenting practice. This study investigates the utility and acceptability of a personalised video consent tool to enhance patient satisfaction in the preoperative consent giving process. DESIGN: A single-centre, prospective pilot study using questionnaires to assess acceptability of video consent and its impacts on preoperative patient satisfaction. SETTING: A single National Health Service centre with individuals undergoing surgery at a regional spinal centre in the UK. OUTCOME MEASURE: As part of preoperative planning, study participants completed a self-administered questionnaire (CSQ-8), which measured their satisfaction with the use of a video consent tool as an adjunct to traditional consenting methods. PARTICIPANTS: 20 participants with a mean age of 56 years (SD=16.26) undergoing spinal surgery. RESULTS: Mean patient satisfaction (CSQ-8) score was 30.2/32. Median number of video views were 2-3 times. Eighty-five per cent of patients watched the video with family and friends. Eighty per cent of participants reported that the video consent tool helped to their address preoperative concerns. All participants stated they would use the video consent service again. All would recommend the service to others requiring surgery. Implementing the video consent tool did not endure any significant time or costs. CONCLUSIONS: Introduction of a video consent tool was found to be a positive adjunct to traditional consenting methods. Patient-clinician consent dialogue can now be documented. A randomised controlled study to further evaluate the effects of video consent on patients' retention of information, preoperative and postoperative anxiety, patient reported outcome measures as well as length of stay may be beneficial.