Imaging the spine for tumour and trauma – A national audit of practice in Irish hospitals

Kelly, J.C.; O’Briain, D.; Kelly, Gemma; Cabe, J.P. Mc

doi:10.1016/j.surge.2011.01.007

Cited by 5 publications

(3 citation statements)

References 18 publications

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“…The deficit in trained spinal surgeons and their services, paralleled with the obvious lack of 24-hour MRI and radiation oncology facilities, highlights the grave deficits that exist in our provision of a national comprehensive system of care for patients with MSCC. 25 We acknowledge that this study has limitations. As with any retrospective analysis based on medical records review, there is the potential for a deficiency of data depending on both the accuracy and the legibility of the notes.…”

Section: Discussionmentioning

confidence: 94%

“…They audited 34 public sector Irish hospitals and found that only 50% had MRI services available from 9:00 AM to 5:00 PM with only 2 of 34 having MRI availability out of hours on a regular basis. 25 Despite MRI first becoming available in 1989 in the private sector in the ROI, there remains a distinct lack of availability of this service in designated cancer centers. This is clearly at variance with NICE guidelines, and such stark deficits are of great concern when faced with appropriately managing a patient with suspected MSCC.…”

Section: Discussionmentioning

confidence: 99%

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Management of Metastatic Spinal Cord Compression in Ireland: Are Surgeons Overlooked?

et al. 2018

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Background: The National Institute of Health and Clinical Excellence (NICE) provide a framework of evidencebased guidelines for the management of metastatic spinal cord compression (MSCC). We aimed to compare our center's provision of service to these best practice guidelines and discuss key shortcomings with their implications for the spinal surgeon. Methods: Patients with radiologic evidence of MSCC over a 30-month period were identified using the hospital electronic radiological database. A chart review was performed analyzing MSCC management. Results: Forty-one patients were identified. Pain was the most common presenting complaint, occurring in 76% of patients. Radiotherapy alone was the most common therapy employed (93% of patients). A surgical opinion was sought for 51% of patients. Histological diagnosis of the causative lesion occurred in 5 patients from surgical specimens. Conclusions: Incongruities between NICE guidelines and our practice exist. Early involvement of the spinal surgical services needs to be encouraged. Establishing a histological diagnosis of the spinal lesion should be seen as of therapeutic importance.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Management of Metastatic Spinal Cord Compression in Ireland: Are Surgeons Overlooked?

et al. 2018

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“…The previous literature on the predictive nature of SC signal change for the clinical baseline and outcome in patients with SCI is sparse. A detailed literature search of SCI and MRI signal change was performed with a systematic review [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ] ( Table 1 and Table 5 ). Fourteen studies met the inclusion criteria, as defined as being prospective and examining acute SCI, MRI, and adverse events [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ...…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Signal Change on Magnetic Resonance Imaging May Predict Worse Clinical In- and Outpatient Outcomes in Patients with Spinal Cord Injury: A Prospective Multicenter Study in 459 Patients

Jentzsch

Cadotte

Wilson

et al. 2021

JCM

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Prognostic factors for clinical outcome after spinal cord (SC) injury (SCI) are limited but important in patient management and education. There is a lack of evidence regarding magnetic resonance imaging (MRI) and clinical outcomes in SCI patients. Therefore, we aimed to investigate whether baseline MRI features predicted the clinical course of the disease. This study is an ancillary to the prospective North American Clinical Trials Network (NACTN) registry. Patients were enrolled from 2005–2017. MRI within 72 h of injury and a minimum follow-up of one year were available for 459 patients. Patients with American Spinal Injury Association impairment scale (AIS) E were excluded. Patients were grouped into those with (n = 354) versus without (n = 105) SC signal change on MRI T2-weighted images. Logistic regression analysis adjusted for commonly known a priori confounders (age and baseline AIS). Main outcomes and measures: The primary outcome was any adverse event. Secondary outcomes were AIS at the baseline and final follow-up, length of hospital stay (LOS), and mortality. A regression model adjusted for age and baseline AIS. Patients with intrinsic SC signal change were younger (46.0 (interquartile range (IQR) 29.0 vs. 50.0 (IQR 20.5) years, p = 0.039). There were no significant differences in the other baseline variables, gender, body mass index, comorbidities, and injury location. There were more adverse events in patients with SC signal change (230 (65.0%) vs. 47 (44.8%), p < 0.001; odds ratio (OR) = 2.09 (95% confidence interval (CI) 1.31–3.35), p = 0.002). The most common adverse event was cardiopulmonary (186 (40.5%)). Patients were less likely to be in the AIS D category with SC signal change at baseline (OR = 0.45 (95% CI 0.28–0.72), p = 0.001) and in the AIS D or E category at the final follow-up (OR = 0.36 (95% CI 0.16–0.82), p = 0.015). The length of stay was longer in patients with SC signal change (13.0 (IQR 17.0) vs. 11.0 (IQR 14.0), p = 0.049). There was no difference between the groups in mortality (11 (3.2%) vs. 4 (3.9%)). MRI SC signal change may predict adverse events and overall LOS in the SCI population. If present, patients are more likely to have a worse baseline clinical presentation (i.e., AIS) and in- or outpatient clinical outcome after one year. Patients with SC signal change may benefit from earlier, more aggressive treatment strategies and need to be educated about an unfavorable prognosis.

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Reliability analysis of the AOSpine thoracolumbar spine injury classification system by a worldwide group of naïve spinal surgeons

et al. 2015

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Imaging the spine for tumour and trauma – A national audit of practice in Irish hospitals

Cited by 5 publications

References 18 publications

Management of Metastatic Spinal Cord Compression in Ireland: Are Surgeons Overlooked?

Management of Metastatic Spinal Cord Compression in Ireland: Are Surgeons Overlooked?

Spinal Cord Signal Change on Magnetic Resonance Imaging May Predict Worse Clinical In- and Outpatient Outcomes in Patients with Spinal Cord Injury: A Prospective Multicenter Study in 459 Patients

Reliability analysis of the AOSpine thoracolumbar spine injury classification system by a worldwide group of naïve spinal surgeons

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