Lumbar Surgery AuditLumbar Surgery AuditPeriod 1Period 1stst Jan 2007- 31 Jan 2007- 31stst Dec 2007 Dec 2007

Presented at Britspine 2008Presented at Britspine 2008

4 teaching Hospital consultants 4 teaching Hospital consultants

2 District General Hospitals2 District General Hospitals

Lumbar discetomy AuditLumbar discetomy Audit116 discetomy by 5 surgeons116 discetomy by 5 surgeons

4 incidental durotomy 4 incidental durotomy one psuedomenigocoeleone psuedomenigocoele

3.48% Comparable to reported literature3.48% Comparable to reported literature

The raw data by surgeon is The raw data by surgeon is given, the data does not permit given, the data does not permit

analysis as different criteria analysis as different criteria have been used.have been used.

Lumbar discetomy AuditLumbar discetomy AuditSurgeon 1Surgeon 118 patients18 patients

Pre op ODI 55 post op 28Pre op ODI 55 post op 28

Pre op VAS 7.6Pre op VAS 7.6 post 3.6 post 3.6

Follow up 11 of 18 61%Follow up 11 of 18 61%

Lumbar discetomy AuditLumbar discetomy AuditSurgeon 1 Surgeon 1

11 with FU of 18 patients11 with FU of 18 patients

-20

-10

0

10

20

30

40

50

60

70

1 2 3 4 5 6 7 8 9 10 11

Change in ODI

Lumbar Decompression AuditLumbar Decompression Audit Surgeon 1 Surgeon 1

Open procedures for L4/L5 stenosisOpen procedures for L4/L5 stenosis age over 50age over 50

5 decompressions5 decompressions 19 interspinous distraction devices19 interspinous distraction devices

Two incidental durotomyTwo incidental durotomy Two spinous process fractureTwo spinous process fracture 3 listed for revision 1 revised 3 listed for revision 1 revised

Lumbar Decompression AuditLumbar Decompression Audit Surgeon 1 Surgeon 1

Pre op oswestry 45Pre op oswestry 45 Pre op walking 160Pre op walking 160 Pre op vas 7.58Pre op vas 7.58 Fu 13 out of 24Fu 13 out of 24 Oswestry 34Oswestry 34 Walking 713Walking 713 Vas 5.4Vas 5.4

Surgeon 2Surgeon 2

SINGLE LEVEL UNILATERAL PRIMARY DISCECTOMIES

SINGLE LEVEL UNILATERAL PRIMARY DISCECTOMIES

Surgeon 2

Total number of spine operations – 43

Single level unilateral primary discectomies – 24

01/01/2007 to 31/12/2007

OSWESTRY DISABILITY INDEX *( AVAILABLE FOR ALL PATIENTS )

Surgeon 2

Mean Pre operative

score

Mean Post operative

score(6 weeks post-

op)

30.04 18.63* Score out of 50

OSWESTRY DISABILITY INDEX

Surgeon2

Mean Pre

operative score

Mean Post

operative score

( 6 weeks post op )

Mean Post

operative score

( 6 months

post op )

27.86 16.29 10.86

COMPLICATIONSSurgeon2

• Infection / dural tear / DVT / bladder disturbances } Nil

• Leg weakness } 1 patient had post operative foot drop resolved at clinic visit• Recurrence 1

Surgeon3

01-04-07 to 30-09-07

Primary Lumbar Discectomy

< 50 years

Surgeon3

Retrospective review of casenotes

Total Male 8 Female 6

Age 21- 30 3 31- 40 7 41- 50 4

Surgeon3

Type Bulge 1 Contained 8 Sequestered 1 Hard 3

Cauda equina 1

Surgeon3

Follow-up < 1 month 8 < 2 2 3 2 9 2

Results Good/ex 11 Moderate 2 Poor 1

Surgeon 4

27 microdiscectomies

• 1 late pseudomeningocele

• 1 wrong level diagnosis on CT (cauda equina)

Surgeon 5

23 microdisccetomies 1 L3/4 6 L4/5 16 L5/S1

Complications 1 significant epidural bleeding 1 temp urinary retention / quads weakness

Surgeon 6

27 microdiscectomies 1 cauda equina 14 L4/5 12 L5/S1

Complications 1 dural tear 1 recurrence – settled conservatively

Outcomes 10 pre-op & 6month post-op complete 9 pre-op only 8 no data

Results (n=10) Surgeon 6

51

16

70

15

67

26

0

10

20

30

40

50

60

70

80

90

100

ODI VAS leg VAS back

Pre-opPost-op

Surgeons 4,5,6

77 microdiscectomies 6 complications

Poor collection of outcome data