TDR is as effective as ACDF and superior for some outcomes. Disc replacement reduces the risk of adjacent segment disease. Continued uncertainty remains about degeneration of the prosthesis. Long-term surveillance of patients who undergo TDR may allow its routine use. Cite this article: Bone Joint J 2018;100-B:991-1001.

Students with exposure to an operating theatre outperformed those students exposed to just classroom teaching. Students indicated an increased preference for teaching through the operating theatre scene. One in three final-year medical students had difficulty identifying the need for a neurosurgical referral.If neurosurgical teaching were further enhanced at medical school, it could lead to increased confidence and efficiency in junior-year doctors when facing the neurosurgical referral process. Increased exposure to clinical neurosurgery may significantly improve the ability of future doctors to tackle neurosurgical scenarios.

BackgroundConventional electronic screen visualisation formats, which use tabs, dropdown menus, lists and multiple windows, present huge navigation challenges to health professionals. A unifying and intuitive interface for the electronic patient record (EPR) has been an elusive goal for software developers for decades.MethodsSince 2009, by working in an agile way, we have built and implemented a fully operational and dynamic system, the University Hospital Southampton Lifelines (UHSL), within our clinical data estate, in a UK university hospital. UHSL permits the continuously updated display of the EPR on a single desktop computer screen in an intuitive format. During this iterative evolution, we have resolved a number of practical challenges in data display, while maintaining our core aims of end-user optimisation and radical simplification of the interface. Concurrently, we have upcycled a significant volume of clinical e-content, some from as far back as 1991, into UHSL, and at a marginal cost.OutcomesUHSL went live in 2017 for all authorised staff at the hospital. It displays all e-records for 2.5 million patients and for more than 100 million documents and reports. It significantly reduces the screen time to navigate the individual EPR, and it offers substantial productivity gains in designated clinical services.ConclusionsUHSL has considerable further development potential as a National Health Service EPR interface, for the integration, display and ease of understanding of medical records across primary, secondary and community care.