Spinal Surgery

CCGs and trusts to agree local plans to implement and adhere to the National Back & Radicular Pain Pathway.

Mandatory use of National Neuromodulation Registry for Spinal Cord Stimulators.

Trusts to follow SBNS and BASS guidance on the management of patients with suspected cauda equina syndrome, including urgent referral by a senior decision-maker to a 24-hour MRI scanning service performed locally in the hospital of presentation, ensuring no delay. Radiologists must prioritise these patients in light of the syndrome's severity and the time-critical nature of effective treatment.

Spinal hubs (a spinal hospital with 24/7 spinal consultant on-call) to implement electronic emergency referral systems, that allow effective two-way communication between and within trusts.

All major trauma centres to have 24/7 ability to stabilise and decompress patients with fractured and/or dislocated spines.

Additional SCI beds, including ventilation beds, to be funded in the system.

Full addressee: NHS England

Develop a standardised mobilisation protocol for patients with a SCI, based on international recognised practice, and improve recording and monitoring of outcomes through the National Spinal Cord Injuries Database.

All providers, including Independent Sector providers, to be part of a Regional Spinal Network. Clinicians, including allied health care practitioners, to actively engage in their Regional Spinal Networks.

Review the list of trusts that are designated specialist spinal surgery centres and that non-specialist trusts are not remunerated for undertaking specialist work. Specialist top-ups phased out and tariff restructured so that specialist centres are appropriately remunerated for the specialist activity they undertake and are not incentivised to perform non-specialist work.

Review of minimum surgeon and provider volumes for a range of rare spinal conditions and complex spinal surgeries, including adult spinal thoracolumbar degenerative deformity surgery and paediatric spinal deformity surgery. Spinal societies asked to make recommendations.

BASS to review NICE guidance and recommendations on the appropriate use of vertebroplasty and kyphoplasty and timing of intervention.

The BSS and the Spinal Services CRG asked to define criteria in the 16-18 age group that should be treated as a paediatric case.

CCGs to ensure that all primary care referrals for paediatric deformity surgery go through their local paediatric deformity unit. A central paediatric deformity referral management tool is used to ensure that cases go to the correct geographical centre with appropriate skill sets and shorter waiting times.

Spinal Services CRG (NHSE) asked to review service specification for Type I and Type II Paediatric Scoliosis Surgery.

SBNS, BASS and BSS asked to collate and disseminate evidence on best practice in reducing hospital length of stay and supporting early discharge.

All spinal surgical interventions to be recorded on the British Spine Registry.

Implement a range of specific measures to ensure that spinal surgery implants are introduced and adopted in line with emerging evidence and best practice, and that comprehensive data is collected to support appropriate dissemination.

Mandatory requirement for trusts to participate in Public Health England's surveillance of SSI post-spinal surgery.

Training across the spinal specialties and within trusts to be strengthened by funding the Spinal Training Interface Groups and reviewing the ongoing training provided by trusts in relation to spinal services.

Urgently implement measures to reduce litigation costs by applying GIRFT's five-point plan, adopting best-practice consenting processes, and adhering to guidance on the management of suspected CES.

Instigate pricing transparency in procurement for spinal surgery and use the resulting insight to deliver more cost-effective procurement.

Industry to publish details of financial and non-financial support they provide directly or indirectly to individuals or units.