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Introduction Provision of day case spinal procedures in the UK is below expected standards and there is a need for the creation of guidance and patient pathways to address this. Here we present a day case lumbar discectomy protocol and evaluate its impact at our institution. Methods A new pathway (incorporating defined selection criteria, patient education, anaesthetic protocol and discharge prescriptions) was implemented for all suitable patients within a single surgeon’s cohort. Day case rates for lumbar discectomy were compared before and after implementation. Patient feedback was collated using a patient-reported experience measure. Results Eighteen of 23 patients selected as suitable via the pathway successfully underwent day surgery, leading to an increase in lumbar discectomy day case rates from 25% to 69% at our institution. Nearly all patients were satisfied with their experience, although a significant proportion felt provision of postoperative analgesia could be improved. Conclusion We present a day surgery pathway for lumbar discectomy that is safe and effective. This could be more widely implemented to increase day case rates.

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Treatment for a large symptomatic syrinx associated with a Chiari 1 is predominately surgical, via a foramen magnum decompression (FMD), with the aim to normalise cerebrospinal fluid (CSF) movement. Whilst theories of underlying hyperdynamic states in Chiari 1 and Syringomyelia exist, to date there is no effective medical treatment to reverse Syringomyelia. A 17-year-old female was referred with a seven-month history of gradually progressive impaired temperature sensation in her left upper limb. She had also been concomitantly diagnosed with thyrotoxicosis. Magnetic resonance imaging (MRI) confirmed a Chiari 1 with a large syrinx. The patient preferred to avoid surgery in the first instance. She underwent treatment for her thyrotoxicosis. The eight-month, 20- and 36-month follow-up MRI scans demonstrated a gradual resolution of the Chiari 1 malformation and the syrinx. Whilst there have been reports of Chiari 1 malformation association with hyperthyroidism, this is the first report describing syrinx resolution following treatment of thyrotoxicosis. Hyperdynamic circulation can result in syrinx formation through various mechanisms. We hypothesise that the treatment of thyrotoxicosis resulted in normalisation of CSF pulse amplitude and subsequent syrinx resolution. Hyperthyroidism evaluation may be explored in studies of CM1 and Syrinx or other CSF disorders.

doctors on a range of topics. Consensus amongst peers was that teaching sessions often were not particularly relevant to the needs of junior doctors.A peer-to-peer teaching scheme was launched for Foundation Year 1 (FY1) doctors in February 2018. A one-hour session dedicated to peer teaching was allocated once or twice a month within protected teaching time. Three speakers were assigned per session, each delivering a 15-20 minute presentation. Content was left to the discretion of the FY1 doctor presenting, and frequently centred around common on call scenarios.13 FY1 doctors presented topics within the peer teaching programme in the remaining 6 months of the Foundation Year 1. An end-of-year evaluation survey showed that feedback of the scheme was largely similar to regular teaching sessions, with a higher overall rating.Reflecting on our positive feedback, going forward we ensured that the programme continued to be offered to the FY1 doctors starting in August 2018, and expanded the programme to FY2 doctors.Acting upon feedback, the presentation time was lengthened to 30 minutes for the FY2 programme in order to allow the speaker to explore their chosen topic in more depth. We also developed a teaching syllabus based on the core medical/surgical curriculum to encourage teaching tailored towards membership exams.Compared to last year's FY1 programme, we have seen an increase of nearly 40% in teaching participation this year with 18/54 FY2 doctors presenting topics.We believe the positive uptake of the peer teaching programme reflects a positive engagement of junior doctors in their education, which we hope will carry through to their clinical work on the wards.