UKSSB Quarterly eBulletin
June 2016



Society / Registry reports


British Association of Spine Surgeons (BASS)

President – Am Rai

The new BASS executive elected by the membership at Britspine in Nottingham is listed below:









President Elect




Audit & Registry




Education & Training








Trainee representative
Professional Practice
NICE Guidelines and Policy


Over the last year, the BASS consent group has produced several surgical procedure specific information leaflets and new consent forms to increase patient awareness and the consent process. These will be available from the BASS website.
The BASS website will be undergoing a significant upgrade in the next few months, to improve functionality and become a key resource for all spinal surgeons, including trainees.
The British Spine Registry continues to grow and has recently been upgraded. We would encourage all spinal surgeons to make the registry a routine part of their practice.
The executive is keen to bring together all units interested in new research projects. It is important that the spinal community works together to advance research and produce meaningful results. All those interested should contact Jake Timothy jaketimothy@mac.com.
In the coming year the executive will continue to actively engage in all areas that affect spinal surgery. BASS encourages all spinal surgeons, neurosurgical and orthopaedic, to become active members of the association.


British Scoliosis Society (BSS)

President – Bob Crawford
The BSS thanks Nas Quraishi and the Nottingham team for all their work in putting on a stimulating and enjoyable Britspine meeting.
BSS BritSpine Proceedings
            Adult Spine Deformity guidelines: A progress report was given
An English language Pubmed literature search of the past 10 years yielded 5356 potentially relevant articles.  After screening this was whittled down to 65 articles based on RCT or prospectively gathered data, Dr Joost Van Middendorp, project Director, is constructing the data extraction table to address the 60  key questions identified by the Steering Group who will then produce relevant evidence based guidelines.
            Magec Rod surveillance and debate:     A national audit by Irfan Siddique reported that since 2010, 736 rods have been implanted by 52 surgeons in 17 units in the UK and 17 have been explanted.  Detailed audit data were received from 21 of the 17 units about 369 rods in 195 patients.   Amongst other data unplanned revision surgery was reported in 43 patients (22%)
            A debate was held at the Britspine  on the motion ’Magec Rod - Trick or Treat?’ staging Colin Nnadi and Andrew O'Brien in favour of the implant versus Mike Gibson and Sashin Ahuja against it ( The debate became quite lively with some telling blows being landed by both sides,  but without clear conclusion
            Scoliosis school screening: The UK National Screening Committee asked BSS for an update on their previous recommendation from 2012. The Executive Committee agreed unanimously that the evidence remains that screening should not be adopted as a national policy because, given the imprecision of clinic screening methods,  the potential harm ( of x-rays and unnecessary treatment)  outweighs potential benefits. 
            BSS website:  This site, (thanks to the hard work of Vinay Jasani), is now live and providing a useful resource for members, the general public and patients. For members, there is online access to the SRS journal ‘Spine Deformity’, E-Spine, and a variety of useful documents (eg the UK National Screening Committee document on Screening for Adolescent Idiopathic Scoliosis ). For patients there is  a large amount of well-written and illustrated material.
            British Spine Registry:  The Mandatory Dataset for spinal deformity surgery  is now set up on the British Spine Registry and completion is required ( for payment ) by the NHSE D14 contract  This was fully endorsed by the BSS AGM   in Sheffield last year. 
            Next BSS meeting:  the annual meeting of the BSS is being hosted by the Middlesborough team in Hardwick Hall, Sedgefield,  Co Durham on 14.10 2016,  Further details are on the BSS website. 


Society for Back Pain Research (SPBR)


President – Lisa Roberts

Annual meeting Preston November 3-4th November 2016
Keynotes have been planned and include:
   New Directions in Back Pain Consultations – Dr Lisa Roberts
   New Directions in Back Pain Management – Dr Nick Hacking
   Role of 3D printing in orthopedic surgery – Professor Justin Cobb
   Consent and research – TBC
A panel discussion of the NICE clinical guideline on low back pain and sciatica with contributions from SBPR members (Professor Nadine Foster and Dr Serena Bartys) and members of the NICE Guideline Development Group (Dr Ian Bernstein and Professor David Walsh).
This very friendly meeting includes wide ranging first class research presentations across the spinal field and the opportunity to network with many professional groups
Abstract submission is welcome from members and non members of the Society.and closes on 10 July 2016 Details are available http://www.sbpr.info/meetings/sbpr-2016-preston

Travelling Fellowships
Seven UKSSB supported travelling fellows reported on their work at BritSpine. The range of activity was impressive and the Fellowship awards are leading to publications and the development of new research collaborations. Titles of the awards and fellows:
   A European collaboration on a project for antibiotics for LBP - Dr Majid Artus
   Assisting ‘significant others’ in the collaborative self-management of pain - Dr Serena Bartys
   An investigation into roles of Spinal Extended Scope Physiotherapy Practitioners (ESP) within the Acute NHS setting - Jill Billington and Catherine Kelsall
   Normal biomechanics of the lumbar spine: a quantitative fluoroscopy and electromyography study - Alister du Rose
   Investigating variation in lumbar spine curvature in asymptomatic individuals with modic changes and lumbar disc degeneration - Dr Anastasia Pavlova
   Visit to Insight Centre for Data Analytics: Collaboration towards the development of wearable technologies for classification and personalised therapies for back pain - Dr Liba Sheeran
   The science of spinal pain: the way forward for improved management for people with back pain - Dr Valerie Sparkes
This year UKSSB has doubled the grant value. The call for this year schemes has been published: http://www.sbpr.info/news/2014/12/03/sbpr-travel-fellowships-2016 The closing date for this years application was the 2nd of May 2016.

EuroSpine meeting

SBPR president Dr Lisa Roberts is attending the Eurospine specialty meeting in Krakow for SBPR to join Eurospine as an institutional member.

NICE Consultation – Draft Clinical Guidelines for Low Back Pain and Sciatica

Many helpful responses were received from members contributing to SBPR stakeholder feedback on the draft guidelines.. Elaine Buchanan collated and submitted the response from SBPR.
Steven Vogel Secretary, Society for Back Pain Research

Society of British Neurological Surgeons (SBNS)

President - Richard Kerr

Recent highly successful SBNS meeting in Newcastle with dedicated spinal sessions, and the Life Long learning session entitled Spine – Where Orthopaedics and Neurosurgery meet.

This very well attended part of the conference was organised by Mr Adrian Casey, with lectures from Vittorio Russo from Queen Square, Kia Rezajooi and Sean Malloy from Stanmore and James Allibone from Queen Square and Stanmore. The session reviewed spinal problems, the interface between orthopaedics and neurosurgery, and areas of joint working. Adrian Casey spoke about the problems of disease around the C-C junction.

There were also wide ranging dedicated spinal sessions combining presentations and free papers. 


The Walton Centre in Liverpool was the first neurosurgical unit to receive a CQC visit the outcome of which is awaited. SBNS is working directly with the CQC to optimize appropriate metrics.

The National Neurosurgical Audit Project (NNAP) is now on the list of National Registries and has been presented to Sir Bruce Keogh who was very supportive. Contribution to NNAP may become mandated though the CQC.

We await the results of the changes in the configuration of the CRG’s, with the proposals for spinal services.
Next meetings

Contributions from all colleagues are welcome
September 2016 - Telford, currently open for submissions
March 2017 - Oxford
September 2017 - Liverpool

British Orthopaedic Association (BOA)
Alistair Stirling

BOA National Clinical Leaders Programme (CLP)
There are limited places available on the BOA Clinical Leaders Programme. 
Currently, candidates can either apply via their Trust, as an individual or through their specialist society (providing they are sponsoring a place on the programme). More information can be found on the BOA website.

RCS report: ‘Smokers and overweight patients: soft targets for NHS savings?’

An RCS report released last week showed that 22% of CCGs used mandatory BMI thresholds on referrals for Hip and Knee Replacement, and 12% of CCGs required smoking cessation before referral for routine surgery. Please see BOA website for full Report. It is anticipated similar criteria may be applied to other surgery , including spinal surgery
In opposition to these restrictions on patient care, the BOA supported the report. Labour then questioned Government and, in response, a DH Minister stated he would not take any action against CCGs. Please see BOA website for full report.

BOA T&O Curriculum App - new update

The BOA T&O curriculum app has been updated to match the current curriculum, incorporating and changes recently made. The app offers the full version of the T&O curriculum in an easy to read format allowing for quick access. This includes spinal surgery.
The app is available on both Android and Apple devices. If you have already downloaded the BOA T&O curriculum app you will be asked to install the latest update. If you would like to download the curriculum app on an Android device please follow this link, for all Apple devices please visit here. If you have any problems with downloads please contact policy@boa.ac.uk.

Undertaking Clinical Trials in Trauma and Orthopaedics

The BOA Orthopaedic Surgery Research Centre (BOSRC) is running its second meeting for trauma and orthopaedic surgeons interested in getting involved in Randomised Controlled Trials (RCTs) or research grant applications, either as a chief investigator or as a co-applicant on 27th-28th June 2016. Please see BOA website for full report.

British Spine Registry (BSR)

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

British Association of Spinal Cord Injury Specialists (BASCIS)

Ali Jamous - President
Nigel Henderson –UKSSB BASCIS representative

1. The CRGs for spinal cord injury(SCI) and for complex spinal surgery are to be merged to form a new CRG to be known as “Spinal Services”. The last meeting of the SCI CRG was on 12th April 2016. We look forward to working in partnership with complex spinal surgery in the new arrangement.

2. The NHS England Specialised Commissioning Review of SCI services in England is well underway. Service Review workstreams established by the SCI CRG will continue with the current membership as an expert working group of the new CRG. The workstreams are: Access to Services, Specification of Services, Performance of Services, Quality of Services, Patient Experience and Rehabilitation into the Community, Measurement and Research, and Option Appraisal.

3. The planned Peer Review of spinal cord injury centres (NHS England Quality Surveillance Team) is establishing parameters to assess compliance with specifications focusing on patient pathway and experience. These will occur during late summer and early autumn.

4. Next meeting Oswestry Thursday 23rd June to be followed by the Annual Multidisciplinary Guttmann meeting on Friday 24th June.

5. 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)
Lisa Roberts

Lisa Roberts and Alistair Stirling attended the third Eurospine spring specialty meeting in Krakow on the 12th- 13th of May.
This focused on spinal trauma. It was clear from the presentations that a much more Interventional approach is generally in use on the continent. This was counterbalanced by comment from the UK and in particular experience from Oswestry with conservative management of traumatic spinal-cord injury patients .

On the political front it is suggested some progress has been made through UEMS towards recognition of a spinal surgical specialty within Europe. A curriculum group, currently without British representation is making progress with a view to an improved European spine course diploma. Discussion occurred about British input into this and is being progressed.

A lunchtime European spinal societies advisory board (EUSSAB) meeting took place. The principal points were:
   National societies may each have a representative on the board but voting rights will be limited to one vote per country.
   The EUSSAB board will have a single seat on the SSE Executive committee
   This individual will be selected by the EUSSAB board with a view to serving for a period of two years to ensure continuity of process.
   Research grants are available. These will normally be for Euro10 to 100,000. The principal applicant will be required to be a full member of SSE. The intention is these should be used as pump priming form for more major grant applications.
   A new director of education and research has been appointed Julie-lyn Noel noel@eurospine.org
   The next Eurospine meeting is in Berlin from 5-7 October 2016
   UKSSB , SBPR and BASS are institutional members of SSE. At present BSS is not and may wish to consider this.
   EuroSpine Newsletter - LINK

Presentation from Belgium “Spine specialists vs. policy makers in Belgium: a call for change“ by Dr. Bart Depreitere during EuSSAB Meeting in Kraków


In 2014, a report of the Christian Mutuality on spine surgery practice variation, spine surgery associated sick leaf as well as failed back surgery syndrome numbers in Belgium, coincided with the election of a right-winged cabinet eager to cut in the healthcare budget and with a revival of a longstanding question to reform the outdated spine surgery reimbursement code list. This coincidence placed spine surgery in the spotlight as an area where a lot of money could be saved. The Spine Society of Belgium (SSBe) received the task of modernizing its surgical code list, along with the duty to establish a framework of measures for quality improvement and measures that should reduce the numbers of spine surgeries. To increase pressure and achieve short-term savings, the government decided to cut the reimbursement for spinal implants by an average rate of 30%.

The SSBe, established in 2012 as a society representing spine care activities of orthopedic surgery, neurosurgery and physical and rehabilitation medicine, requested a platform for direct communication with the policy makers, which resulted in the creation of an ad hoc spine task force in March 2015. In this platform, the SSBe presented figures on evolutions of spine and other locomotor surgeries in Belgium and abroad in order to draw the exact contextual background on spine surgery practice. Also, the SSBe took the lead at the very first task force meeting by launching a set of quality enhancing measures including a spine registry, guidelines, better registration of actual practice through a modernized code list, peer review committees for decisions on extensive surgeries and installment of multidisciplinary clinics. The policy makers embraced all proposals, however, this was accompanied by a strong wish from their side to couple reimbursement to fulfillment of the above criteria as compulsory requirements as well as a wish to only reimburse spine surgery in a limited number of hospitals only. This felt to the SSBe representatives as an over-rigorous measure that would never achieve sufficient support for effective implementation and that would even not be realistic. Dialogue was kept up and finally resulted in a proposal on spine units acceptable to all parties: each hospital can become a spine unit if they fulfill a set of staffing criteria and minimal service requirements, outline their management algorithms in a spinal handbook – for which a template will be provided-, register a predefined set of indications through Spine Tango and organize a multidisciplinary clinic one a month. This spine unit concept will allow all centers to enhance quality in a gradual and bottom up manner and come along with the development of a national spine registry, a Belgian guideline (in the form of a template for the hospitals’ spinal handbook) and a modernized spine surgery reimbursement code list.

Currently, texts are being reviewed and are going through the political decision process. A potential role for the industry, e.g. in contributing to fund the registry, still needs to be defined. Ideally, a triple partnership of policy makers, caregivers and industry should be installed in the future in order to maximally facilitate overlapping interests. Finally, it is clear that a positive evolution of this story was only possible due to the creation of a united multidisciplinary national spine society that could speak with one voice as well as to the conviction that aiming for improved quality is the only way forward for our field.