Survey of non-spinal orthopaedic consultant surgeons at three district general hospitals regarding regional spinal services

Abstract

Patients with emergency spinal pathologies such as suspected cauda equina syndrome are often admitted under non-spinal orthopaedic surgeons at district general hospitals (DGHs). Emergent investigation in the form of magnetic resonance imaging (MRI) is frequently required prior to potential referral to the tertiary spinal centre despite many DGHs not having out-of-hours MRI provision. Anecdotally, there is considerable anxiety among non-spinal orthopaedic surgeons working in DGHs around the admission and investigation of emergency spinal pathologies under their care. We sought to survey and formalise the opinions of non-spinal on-call orthopaedic consultants at three DGHs with regard to admission, investigation, local infrastructure and regional support provided to them when emergency spinal pathologies are admitted under their care. The consultants surveyed reported being very uncomfortable managing emergency spinal cases admitted under their care. It was felt that the hospitals provided inadequate infrastructure, especially in terms of obtaining timely imaging. There is a lack of local outpatient spinal provision, a lack of consistent advice from the regional centre, and a feeling of patient, personal and organisational vulnerability with the current implementation of the regional spinal pathway. There was a high preference for a restructuring of the spinal pathway as well as a desire for on-site spinal opinions. The results of this survey demonstrate the considerable unease experienced by non-spinal trauma and orthopaedic consultants at district general hospitals with regard to the management of spinal pathology. We hypothesise that this is not limited to this region but is a sentiment echoed nationally.