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Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_III | Pages 530 - 530
1 Aug 2008
Shaw M Pearce M Foy M Fogg A
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Null Hypothesis: All spinal surgeons in the United Kingdom will routinely use X-ray screening in their practice when performing lumbar spinal surgery.

Background: Surgery at the wrong level fortunately occurs uncommonly in spinal surgical practice. When it occurs it is a potential source of morbidity for the patient and may result in litigation for the surgeon. The authors analysed the intra-operative x-ray practice of UK spinal surgeons at the time of discectomy, decompression and instrumented fusion. They also assessed their views on surgery at the incorrect level and x-ray facilities available in their centres.

Method: 130 members of BASS (British Association of Spinal Surgeons) were sent an anonymous postal questionnaire concerning their practice and views on x-ray use at the time of surgery.

Results: 91(70%) questionnaires were returned. There was a large variation in practice between surgeons. 54 percent of surgeons always used x-ray screening for decompression/discectomy procedures whilst 12 percent only used imaging intermittently. The timing of x-ray screening in relation to opening of the ligamentum flavum was also subject to considerable variation. A small number of surgeons never used x-ray screening for pedicle screw insertion and some only used it occasionally. There was a spectrum of opinion on whether wrong level surgery was substandard practice.

Conclusion: The Null Hypothesis has been disproved. There is a wide spectrum of practice and opinion on intra-operative x-ray practice among UK spinal surgeons. Some comments, suggestions and recommendations are made by the authors.


The Journal of Bone & Joint Surgery British Volume
Vol. 76-B, Issue 6 | Pages 947 - 950
1 Nov 1994
Pearce M Smith M Savidge G

We report the results of supramalleolar varus osteotomy on seven ankles (in six patients) for haemophilic arthropathy and secondary valgus deformity. The operation reduced pain and the frequency of intra-articular bleeding while preserving joint function for a mean of nine years. The procedure is an attractive alternative to the more commonly used surgical option of arthrodesis.