Aims and objectives
In 2015 the British Association of Spinal Surgeons published standards of care for suspected and confirmed compressive cauda equine syndrome (CES)1.
In this publication,
they recommend urgent MRIscans are performed in cases of suspected CES.
In addition,
guidelines released by the National Institute of Clinical excellence (NICE) recommend MRI whole spine for adults with suspected malignant spinal cord compression (MSCC) is performed within 24 hours of the suspected diagnosis being made2.
Following the release of these publications,
relevant clinical pathways in our trust were updated...
Methods and materials
All acute OOH spinal MRIs performedover the last 4 years between February 2014 and July 2018 were retrospectively reviewed.
OOH work was taken as scans performed between 7pm and 8am.
Only scans performed for inpatient and patients from the Accident and Emergency department were included.
The radiology reports and key findings were noted.
We crossed referenced all of these patients with the spinal surgery database for the same time period to ascertain the proportion who underwent spinal surgery and in what time period following their...
Results
A total of 250 acute OOH spinal MRIs were performed in this time period.
Figure 1 demonstrates the number of scans performed over the 4 year period per quarter per annum.
When comparing the first 6 month period in 2014 with the same time period in 2018 we demonstrated a 3 fold increase in the number of scans performed before midnight and a 13 fold increase in the number of scans performed after midnight (See Figure 2).
However,
the frequency of overnight spinal surgery over...
Conclusion
Since the introduction of updated clinical pathways pertaining to the management of cauda equina syndrome and malignant spinal cord compression the number of out of hour MRI scans has increased significantly in our trust.
Of patients with positive findings of cord or cauda compression on their MRI,
only 24% underwent same night surgery.
Deciding to operate overnight is complex and requires careful assessment of the benefits versus risks to the patient.
Some factors we identified that seemed to play a role in deciding whether or...
Personal information
Dr P Burn,
Consultant Radiologist,
Radiology Department,
Musgrove Park Hospital,
Taunton and Somerset NHS Foundation Trust,
Taunton,
UK.
Dr H O'Brien,
Radiology Registrar,Radiology Department,
Musgrove Park Hospital,
Taunton and Somerset NHS Foundation Trust,
Taunton,
UK.
Dr G Karnati,
Consultant Radiologist,Radiology Department,
Musgrove Park Hospital,
Taunton and Somerset NHS Foundation Trust,
Taunton,
UK.
Dr J Brown,Consultant Radiologist,Radiology Department,
Musgrove Park Hospital,
Taunton and Somerset NHS Foundation Trust,
Taunton,
UK.
Dr S King,Consultant Radiologist,Radiology Department,
Musgrove Park Hospital,
Taunton and Somerset NHS Foundation Trust,
Taunton,
UK.
References
Germon T,
Ahuja S,
Casey A,
Todd N,
Rai A.
(2015) British Association of Spine Surgeons Standards of Care for Cauda Equina Syndrome.
The Spine Journal 15. 2S-4S.
National Institute for Health and Care Excellence (NICE) 2008,
Metastatic spinal cord compression in adults: risk assessment,
diagnosis and management. Available from: https://www.nice.org.uk/guidance/cg75/chapter/guidance#MSCC-coordinator-and-senior-clinical-adviser-roles-and-responsibilities [22 September 2018].