UKSSB Quarterly eBulletin
June 2016



BritSpine 5-8 April 2016

500 delegates 200 trade delegates

View the summary table of results by Survey Monkey

Brief summaries of some of the highlights are given below
Genetic epidemiology of low back pain
Dr Frances Williams, Reader & Hon Consultant, King’s College London

Frances summarised the important finding from twin studies that lumbar disc degeneration has 68% heritability. Useful in clinic when patients ask ‘why is this happening to me?’  She identified plausible candidate genes and explained how genome-wide association studies are helping identify variants, such as the PARK2 gene.

Frances concluded outlining the exciting PAIN-OMICS work, which is a stratified approach for patients with low back pain that will capitalise on existing high quality clinical, genetic, biochemical and pharmacological data and biological samples of over 5000 patients with low back pain and controls.  It is clear that genetic epidemiology has much to contribute to understanding back pain.


Perspectives on Current Healthcare Developments in England (UK)

Allyson Pollock

Junior Doctors are now paying for the high costs of the market in health care, article
BOA Policy Briefing on Policy briefing on Cities and Local Government Devolution Act 2016
What specialist associations do for spinal surgeons

Colin Howie

What does the BOA do?

Presentation by BOA Past President, Colin Howie

BOA Past President Colin Howie delivered a presentation on the roles and functions of the BOA.  Traditional core workstreams (Training and Education, Research and Professional Practice) continue to be delivered successfully to international standards.

He outlined new developing areas of the BOA’s activities including: advocacy which ranges from high level political engagement to representation and co-operation with governmental departments and reports e.g. with Monitor; communicating with Clinical Commissioning Groups,  and extensive public engagement through ARMA and the BOA Patient Liaison Group.   Behind all  BOA  activities, is a commitment to raising standards, and creating a vibrant, sustainable representative orthopaedic community which delivers high quality effective care to fully informed patients.

Current key activities to support advocacy include:

   Engagement with Specialist societies (to ensure that specialist societies are involved and that the BOA is well informed)
   Development of local clinical networks
   Local and national commissioning activities
   External engagement on wider healthcare issues
   Development of a T&O registries initiative
   Supporting the implementation of GIRFT
   Engagement on Tariff and coding

For more information about the work of the BOA, and how to get involved please contact  policy@boa.ac.uk

Management of Symptomatic Spondylolysis

“If it’s broke, if and when to fix it?”

The development and natural history of pars lesions in professional cricket was presented by Nick Peirce (Chief Medical Officer - England & Wales Cricket Board) Conservative treatment in "young" patients with symptomatic spondylolysis and a normal disc (on MRI scan) was presented by Robin Chakraverty (Chief Medical Officer - British Athletics) This was an excellent session and worth revisiting on webcast .

The range of current surgical approaches was described by Lester Wilson ( direct pars repair ), Thanos Tsirikos (uninstrumented posterior fusion) and Daniel Chan (360 degree fusion).

Overall the conclusion was that even in high level athletes a majority of these will settle with conservative treatment and even if this is unsuccessful direct pars repair via a minimal intervention approach is usually successful.

PCPIE session Friday 8th April 2016 Nick Birch

Spinal cord stimulation
Cauda Equina

On the afternoon of Friday, 8 April 2016 the second BritSpine Patient, Clinician and Researcher Participation session was held, following the successful inaugural event in 2014 at Warwick.

The first hour involved presentations from Professors Fairbank, Eldabe and Al Kaisy to describe an RCT of High Frequency spinal cord stimulation (HF10) that would necessarily involve actual and sham treatment. Six patient representatives from the Nottinghamshire and Leicestershire area and one from London attended and provided direct feedback to the investigators. The facilitators were Jane Stewart and Paula Wray from the local ethics, research and NIHR public involvement organizations. The positive patient responses were very helpful in focusing the investigators’ thoughts on the end-user experience and the potential anxieties of patients volunteering for the RCT.

The second presentation was given by Olivia Chapple, the principal trustee of the Horatio’s Garden charity. She described the work in creating the original garden in Salisbury and the progress made in Glasgow and Stoke Mandeville where the projects are progressing apace. Horatio’s Garden was chosen by UKSSB and the BritSpine 2016 organisers as the nominated charity for the event . Almost £2000 was raised following Olivia’s presentation during the conference dinner at Colwick Hall,
Finally, a lively set of presentations followed by a robust discussion on the thorny issue of Cauda Equina Syndrome wrapped up the afternoon. Nick Todd and Am Rai presented views from the medico-legal and clinical perspectives and Sister Paula Muter from Sheffield gave a vivid description of the urogenital difficulties faced by people who have had CES.

76 people attended (up from 54 in 2014) indicating the value that conference attendees attached to it. The BritSpine 2018 organising committee will be pleased to receive suggestions for topics for the event in Leeds via the UKSSB.