UKSSB Quarterly eBulletin
January 2016





This is intended to include information from each society that is thought will be of interest to the other societies. It is not intended to replace or duplicate internal society newsletters.

British Association of Spine Surgeons (BASS)

President – Am Rai

1. Consent documents project going well with launch at BritSpine
2. VTE guidelines also progressing with plan to discuss at BritSpine, and summary of our recommendation.
3. CES – This has been signed off by both BASS and SBNS and arrangements are underway for distribution and implementation shortly.
4. BSR uptake improving and hopefully will be linked to payment.
5. Elections for several Executive positions available at BritSpine. Would encourage all to apply especially neurosurgeons.


British Scoliosis Society (BSS)

President – Bob Crawford

1. Adult Spine Deformity guidelines. – BSS working party
An evidence-based assessment of adult spine deformity surgery is underway led by Dr Joost van Middendorp employed by BSS (prev. Research Director at Stoke Mandeville Hospital)
Medline search > 5,000 references after screening yielded 278 articles for the evidence base. A ‘Delphic process’ (consensus-seeking approach) has been adopted to obtain best answers to questions posed. Results TBA at BritSpine.

2. Magec rod surveillance
Reports of breakage of this device associated with metallosis have prompted a BSS centre by centre survey, to ascertain the incidence which will be presented and debated at BritSpine.

3. British Spine Registry
The new version has mandatory fields for scoliosis in particular Magec cases. To be released by the end January 2016. Poor compliance to date, however, necessitates the Magec survey currently under way.

4. New BSS website
• See Britscoliosissoc.org.uk, which has a large and expanding patient information section seminal references and a discussion forum.
• AIS specific surgery information document currently in development to assist the patient consent process.
• Membership fees now payable via website link.

5. New BSS membership benefit
BSS membership now includes access to the SRS journal Spine Deformity. The website is currently being modified to allow members access.

6. Patient Liaison
Patient representative being invited to the next Executive meeting via SAUK.


Society for Back Pain Research (SBPR)

President – Lisa Roberts


At the Society for Back Pain Research annual scientific meeting was held on 5th-6th November. The Annual meeting took place at the Anglo-European College of Chiropractic and was hosted by Professor Alan Breen, Clinical Director of Special Imaging at the Institute for Musculoskeletal Research and Clinical Implementation.

The principle highlight was the debate: Is non-specific low back pain a valid concept?

Other highlights from the meeting included keynote presentations from: Professor Maurits van Tulder from The Netherlands on ‘The biopsychosocial model: Time for a new back pain revolution?’; Professor Sally Roberts on ‘Disc degeneration: The how and why’; Dr Judith Meakin on ‘Back pain – too many degrees of freedom?’; and Professor Mark Hancock from Australia on ‘Challenges in researching the importance of biology in back pain’.

The next meeting will take place in Preston on 3rd and 4th November 2016 and the theme will be ‘New trends’.

Report from The Society for Back Pain Research Annual Scientific Meeting Debate:

Is non-specific low back pain a valid concept?


When the initial vote was taken..

..by Professor Nadine Foster who chaired the proceedings, there was a landslide majority in favour of the motion among the 100+ delegates that included orthopaedic surgeons, physiotherapists, rheumatologists, psychologists, anaesthetists, chiropractors, osteopaths, biomechanists and basic scientists.

Speaking for the motion, Professor Charles Greenough, National Clinical Director for Spinal Disorders and orthopaedic surgeon reminded the audience that specific diagnosis was associated with a five-fold increased risk of chronicity and that back pain was responsible for 11% of disablement in this country. He warned against providers treating abnormalities on MRIs and highlighted that false labelling destroys lives. In the 75th anniversary year of the Battle of Britain, he paraphrased: ‘Low back pain: Never in the field of human healthcare has so much been spent by so many for such disastrous results’.

Next, speaking against the motion, Professor Wim Dankaerts from the University of Leuven, Belgium, gave a passionate account of how the concept is based on a diagnosis by exclusion (where no specific patho-anatomical or pathological disorder can be linked to the pain) and argued that the concept is uni-dimensional and fails to recognise that there are specific drivers of pain for which person-centred care can be delivered. He said the concept is as outdated as saying the earth is flat and argued: ‘To have clinical validity, we need a concept that is able to guide clinicians beyond just triaging (based on the absence of patho-anatomical findings) patients into one non-specific LBP box.’

In response, Elaine Buchanan, consultant physiotherapist from Oxford warned against iatrogenesis associated with over-diagnosis as she spoke in support of the motion and asked ‘What is wrong with being honest? We know that clinicians can greatly improve the patients’ response to back symptoms by being honest, admitting our diagnostic limitations, demedicalising the issue, providing assurance, encouraging a more reasonable approach to symptom management and improving activity participation.’ Her conclusion was that non-specific low back pain remains an honest and valid concept.

Finally, Nick Birch, spinal surgeon in private practice spoke against the motion, highlighting the correlation between scan findings for most degenerative conditions was modest at best and absent at worst. He said of the non-specific low back pain concept, ‘The fallacy of this philosophy is that an investigation for pain does not exist – we do not have a pain scanner yet. Current imaging can show that there is no structural cause for a person’s back pain, but it cannot comment on the pain itself. Afterall, a scan is a picture of what a person looks like, not what they feel like.’ He concluded that in 2015, patients know too much about the spine to be ‘fobbed off’ with a term such as non-specific low back pain’.

At the final vote, the margin had narrowed considerably. However, there was still a small majority supporting the motion, which was carried.


The debate: From left to right: Wim Dankaerts; Nick Birch; Elaine Buchanan; Charles Greenough


President Lisa Roberts with local host Alan Breen
(pictures courtesy of Alex Breen)

Click to Show More...



Society of British Neurological Surgeons (SBNS)


1. Mr Paul May has been elected as the next SBNS President and will take up office in September 2016. He is Consultant Neurosurgeon in Liverpool and is Co-Chair of the Trauma Programme of Care Board.

2. Guidelines for the management of Cauda Equina Syndrome have been developed with BASS and will be distributed to all the emergency units, primary care teams and spinal units.

3. There is updated guidance on avoidance of wrong site surgery and neurosurgical standards of care on the SBNS website.

4. Following the last SBNS meeting where a life-long learning session and debate regarding CJD and vCJD was held, we will hopefully be able to publish the most up-to-date guidance regarding this.

5. The next meeting of the SBNS will be held in Newcastle in April 2016.


British Orthopaedic Association (BOA)

Alistair Stirling

A consultation on the Government’s mandate to NHS England to 2020
The Department of Health has recently published its mandate to NHS England, see Reference documents <<<please link to them >>.

The BOA responded to the consultation document for the mandate, arguing that:

• The Department should consider how the mandate can be used to empower the health and care system to meet the needs of patients with musculoskeletal conditions
• Data-rich, clinically-led quality improvement programmes should be recognized as key to improving outcomes
• Low QALY cost treatments, such as Hip and Knee Replacement should be recognized, alongside prevention and supported self-management, as central to achieving the Government’s priority of preventing ill health and supporting people to live healthier lives.

You can find a copy of the BOA’s response

GIRFT Professional Guidance for implementation
has been launched

BOA Letter to Members

MSK Clinical Network

NHS England has partnered with ARMA (Arthritis and Musculoskeletal Alliance) to improve MSK care through the development of MSK clinical networks, as explained by Martin McShane in his recent blog.

If you are the MSK lead in your CCG or work within an MSK service and you want to:
• improve outcomes, increase value and reduce wastage in your local MSK economy,
• access the best national expertise to drive improvement in key areas including metrics and workforce,
• Find out practical solutions and learn from the experience of others.
• Then join ARMA’s MSK Knowledge Network.


British Spine Registry (BSR)

www.spineregistry.co.uk (Data Input)
www.britishspineregistry.com (Information Website)
Mike Hutton

The British Spine Registry (BSR) has seen some healthy growth since June 2015, there is still a long way to go!
There are now 41,921 patients registered on the BSR, a 13% increase since June 2015. There are 815 users registered on the system, 209 of these are actively entering data, a rise of 20% since June 2015.
A new update to the registry is due for release at the end of January. The update will include new features such as:

1. Obvious mandatory field capture in all pathways.
2. The ability to turn on and off mandatory fields in all pathways, (This way the minimum data required is seen on the screen),
3. An operation note print facility,
4. Integrated audit forms for Cauda Equina Syndrome and Magnetically Controlled Growing Rods. (Mention Cauda Equina Syndrome in your assessments of patients on the registry and further relevant questions are asked),
5. The ability to record whether the case is NHS or independently funded.

The update will be notified to all users via the notification section of the registry and via email.

A further update is planned for introduction at BritSpine 2016 in Nottingham. It is hoped this will have reporting tools for revalidation and appraisal.

The BSR has visited a number of centres across the UK over the last 6 months, helping units understand the requirements and costs of effective data capture.

Any unit needing assistance in doing so can contact us (audit@spinesurgeons.ac.uk) to arrange a team registry visit providing a free and independent report on ‘how to set up the registry for your unit’ or to work uploading existing data onto the registry again.


British Association of Spinal Cord Injury Specialists (BASCIS)

Ali Jamous - President
Nigel Henderson –UKSSB BASCIS representative


1. An enquiry into the provision of local health services for people being discharged from spinal cord injury centres, entitled “A Paralysed System?” was published by the All Party Parliamentary Group on Spinal Cord Injury in association with the Spinal Injuries Association in June 2014.

2. NHS England Specialised Commissioning is to conduct a Service Review of spinal cord injury services in England during 2016. This will look at demand, equality of access, the consequences of delays, and the impact on, and from, other services (also see above under Updates – Charles Greenough)

3. The Quality Surveillance Team of Specialised Commissioning, NHS England, is planning to conduct a peer led quality review of spinal cord injury centres during 2016 assessing compliance against service specification with a focus on the patient pathway and experience.

4. BASCIS held its six-monthly business meeting on 21.01.2016. Centres remain under pressure because of unfilled consultant and specialty training posts and, in many areas, nursing shortages.

5. The SCI service in England will move into a shadow tariff in April 2016 using information from the National Spinal Cord Injury Database which is rapidly becoming a comprehensive record of SCI centre activity.

6. The spinal cord injury referral portal, which includes a useful and informative document resource, is available on: www.spinalcordinjury.nhs.uk.



The Spine Society of Europe (SSE)

Phil Sell

UKSSB and all members of the British Association of Spine Surgeons and the Society for Back Pain Research are now associate members of Eurospine as their society has joined EUSSAB, the board of National spine societies across Europe. There are many benefits of this, such as free access to the webcasts of the Eurospine Annual meeting, among others.