Patient information - Spinal Service

Punctuality is highly important when attending spinal osteopathy appointments here at the QMC. If you are late for your appointment we cannot guarantee that you will be seen.

Your first appointment with the osteopath will be a consultation to discuss how osteopathy could help you and to gain your consent for the treatment.

Following this we offer a course of 6 sessions that run for 6 consecutive weeks, at the same time and on the same day of each week. If you are unable to attend one of your appointments this may not be replaced. A second course of treatment may also be offered after the first set is complete.

If this routine would be something you would find difficult to fully commit to, or if you no longer require these appointments, please call us directly at the Spinal Outpatient department to discuss a way of moving forward on 0115 924 9924 ext. 64122.

Due to the complexity of these appointments it is not always possible for us to accommodate changes, however this can also be discussed by calling the above number.

The experience patients have of our department is very important to us and we aim to make you feel safe in this unfamiliar environment. Many patients feel apprehensive and bewildered about their visit to the operating room, whether their need is for elective surgery or as an emergency admission. You can rest assured you will be treated with total dignity in a clean and safe environment.

Theatre Reception

On the day of your spine surgery, you will be escorted from the ward on a theatre trolley or your own hospital bed by a porter. Upon arrival in the theatre reception the team will welcome you and carry out a short check in which to identify you as part of our WHO Patient Safety Check.

Anaesthetic Room

When the team have prepared all the equipment for your surgery a member of the team will collect you, and take you into the anaesthetic room where you will receive a general anaesthetic if appropriate.

Once inside you will meet your anaesthetist who, alongside the scrub practitioner and one of the surgeons attending your surgery, will conduct the Patient Safety Check, where questions about your identity and surgical procedure will be confirmed.

Once you and the team are happy to continue with your procedure the anaesthetist will insert a small needle in preparation to put you to sleep, and you will drift off in no time at all.

Operating Room

Here the full team will carry out your spine surgical procedure to the highest standard, ensuring your safety, dignity and well-being at all times.

Recovery Room

Following your operation we will transfer you on your hospital bed to the recovery room. An assigned nurse will work with you on a one-to-one basis making sure your post operative care is continued to the same high standard. Their aim is to ensure you are pain free and comfortable and any wound drains and urinary catheters will be checked.

When you are able to maintain your own airway and are free of pain you will then be transferred back to the ward with a nurse and porter.

If you have a questions prior to your theatre department care that you wish to discuss with a member of the team then please do not hesitate to contact us.

We are here to deliver our daily vision for your surgical requirements, to the highest standard in a safe and controlled manner.

The Centre for Spinal Studies and Surgery (CSSS) is proud to be able to provide advice and treatment on the entire spectrum of spinal diseases and conditions.

There are many good and reliable sites for information on the internet but it can be difficult to find them. We particularly recommend the information on the websites for the British Association of Spine Surgeons and the Scoliosis Association (UK), some links for which can be found below.

We have also provided links on common disorders in the list below so that you can have quality advice from an independent source that we approve of and is approved. Simply 'click' on the word for more information.
 

• Acute Back Pain
  
  
• Cauda Equina syndrome
  
  
• Lumbar discectomy and decompression
  
  
• Neuromuscular scoliosis
  
  
• Syndromic scoliosis
  
  
• Spinal stenosis
  
  

If English is not your first language then try this link for similar information in German, French, Spanish, Italian, Turkish, or Greek:

• EUROSPINE

An appointment at spinal outpatients will usually be the first step towards treatment for the majority of our patients.

Our clinics have been moved to B Floor, West Block, QMC.
 

The Nursing Team

The clinics nursing team consists of a Deputy Sister, three Staff Nurses and four Nursing Auxiliaries who work with the Consultants during their clinics.

There is also a Specialist Oncology Nurse, a Scoliosis Practitioner, an Osteoporosis Nurse and two Nurse Practitioners who hold clinics alongside the Consultants, as well as a trained nurse who sees post operative patients six to eight weeks after their surgery.

The nurses are there to provide you with information and to give you reassurance, so please feel free to ask them questions. If they don't know the answers they will certainly endeavour to find them out for you. 

In Clinic

Your outpatient consultation will either be with the Consultant you have been assigned to directly,  or with a Fellow of their team or an Extended Scope Practitioner, who will discuss the relevant findings with the consultant later.  In many instances, it will not be necessary for the Consultant to see you personally, often allowing your waiting time to be reduced, but we will always strive to accommodate a direct meeting with the Consultant if you request one.

During your visit to clinic, your Consultant will decide on a plan of care. This may consist of spinal imaging or other investigations, referrals such as physiotherapy, you being listed for a day case procedure (usually to optimise pain relief), you being listed for surgery, or advising your GP on the best course of action and referrals for you.

It is our policy to provide a nurse chaperone for all physical examinations so please feel free to ask for one if a nurse is not immediately present.

As we are a teaching hospital, there are sometimes medical students or surgeons visiting from other units who may accompany the Consultant conducting the clinic. Should you be uncomfortable with the presence of students or visiting surgeons please do not hesitate to mention this to staff. This is in no way mandatory and will not have any effect on your consultation.

Patients who have had simple or standard procedures performed and are progressing well, usually require one or two follow-up appointments. The first is approximately 6-8 weeks after surgery and the other after a year, if implants have been inserted. If, contrary to expectation, progress is not as expected or difficulties arise, you can be referred to our daily drop-in clinics where you will be seen by the Research or Clinical Fellow on-call, who will take the appropriate action. To access the drop-in clinic, please ask your GP to call 0115 849 3377 or fax a short referral to 0115 875 4551.
 

Waiting Times

There are currently long waiting times for new patients to be seen in clinic, so we do warn in advance and are grateful for your patience on the matter. Plans are in place to improve this situation, but may take some time to take effect.
 

Parking

There is a disabled car park outside the department and, whilst other parking is available, it is restricted and patients are therefore strongly advised to use the park and ride wherever possible.

Further information is available on the Trust website at

http://www.nuh.nhs.uk/getting-here/

Useful Contact Telephone Numbers

Switchboard: 0115 924 9924

Email - SpinalOutpatients@nuh.nhs.uk 

Choose the appropriate extension number from the list below:

• ext 81005 - Bev Beeson
  (Speciality PA to Mr Tsegaye and Mr Shafafy)

• ext 81024 - Rachael Blow
  (Waiting List Coordinator to Mr Patel)

• ext 84296 - Chanice Burton
  (Speciality PA to Mr Quraishi & Mr Yoon)

• ext 85160 - Shamell Cable
  (Speciality PA to Extended Scope Practitioners)

• ext 81013 - Dr. Donna-Marie Urbanowicz
  (Speciality PA to Mr Salem, Mr D'Aquino & Mr Grevitt, and Fellowship Co-Ordinator)

• ext 85485 - Laura Hallam
  (Speciality PA to Mr. Patel, Mr. Paskou, Mr. Shah & Associate Spinal Specialists)

• ext 82410 - Lynette Leek
  (Waiting List Coordinator to  Mr Salem & Mr D'Aquino)

• ext 81273 - Angela Cocking
  (Waiting List Coordinator to Mr Quraishi & Mr Tsegaye)

• ext 88469 - Christine Pickard
  (Waiting List Coordinator to Mr Shafafy & Mr Yoon)

Before you undergo surgery on your spine you need to visit the hospital for a pre-operative assessment. This leaflet aims to explain more about the process for you.

What is a pre-operative assessment?

A pre-operative assessment is a check that is carried out ahead of surgery to ensure that you are medically fit for the procedure to be done. This time also gives us the opportunity to talk to you and confirm that you fully understand the procedure you are having.

Who does the assessment?

Your pre-operative assessment will be carried out by your spinal consultant, scoliosis nurse specialist and a spinal assistant practitioner.

How long does it take?

We normally suggest you allow a full morning for the pre-operative assessment.

What happens during a pre-operative assessment?

During the pre-operative assessment you will have some or all of the following tests done depending on your needs:

• Observations including height, weight and blood pressure. Swabs will also be done to check for MRSA.
  
  
• Urinalysis, which tests your urine for infection.
  
  
• Blood test.
  
  
• X-rays.
  
  
• Medical photography. If you are the parent or legal guardian of a child undergoing surgery you will need to sign a consent form.
  
  
• ECG, which records the heart rate and rhythm.
  
  
• Lung functions, which measures the size of your lungs and how efficiently they work.
  
  
• Neurophysiology (nerve tests).
  
  
• Questionnaires, such as those relating to pain.
  
  
• Physiotherapy (only paediatric patients).
  
  
• Occupational therapy (only paediatric patients).

At the end of the pre-operative assessment you will be given an information pack, which includes information on blood transfusion, and a urine sample bottle to take home with you. Female will need to bring in a urine sample on the day of your surgery (female patients only).

Feedback

We appreciate and encourage feedback. If you need advice or are concerned about any aspect of care or treatment please speak to a member of staff or contact the Patient Advice and Liaison Service (PALS):
Freephone: 0800 183 0204
From a mobile or abroad: 0115 924 9924 ext 65412 or 62301
E-mail: pals@nuh.nhs.uk
Letter: NUH NHS Trust, c/o PALS, Freepost NEA 14614,
Nottingham NG7 1BR
www.nuh.nhs.uk

If you require a full list of references for this leaflet please email patientinformation@nuh.nhs.uk or phone 0115 924 9924
ext. 67184.

The Trust endeavours to ensure that the information given here is accurate and impartial.

Hospital Hotel

There is a patient hotel located in the City Hospital campus. Details can be found using the link below:

Patient Hotel information

Medilink

The medilink is a dedicated bus service operated between the City Hospital and the Queens Medical Centre campus.

Our routine practice is to record treatment details and outcome details with validated questionnaires for the purpose of audit, service evaluation and in some instances, research.

All data that is collected is stored anonymously both here at QMC and as part of the European Spine Registry, specific details of which can be found on the Spine Tango website.  All of the information entered into this database is fully anonymised on the British Spine Tango server in Oxford and it is impossible for anyone entering the databank externally to retrieve traceable patient information.

You may also be asked for consent to have your information collected for the British Spine Registry (BSR), a database set up by the British Association of Spine Surgeons (BASS) to monitor the outcomes of spinal procedures with the aim to improve patient safety and increase the understanding of an operation's success.

Patients with Spinal Muscular Atrophy (SMA) may be asked for consent for their details to be added to SMArtNet, an internet-based, national clinical database that has been developed to better understand SMA progression, aid multi-centre clinical investigation, and review the services available to SMA patients. 

If your data is being collected as part of a specific research study you will be invited to participate separately with the option to opt-out.

Please do not hesitate to contact us with regards to any queries you may have in respect of this. 

In order to make your stay/visit to the QMC as comfortable you can find out more about the facilities we have to offer.

Patient Advice and Liaison Service

We are here to help when you need advice, have concerns, want to tell us about what you think about our services, or don't know where to turn.

For more information please visit the below link:

www.nuh.nhs.uk/PALS

National Institute for Health and Clinical Excellence

NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health.

For guidance on various spine disorders please use the below link:

NICE guidance on Spine Disorders

The National Spinal Taskforce

The National Spinal Taskforce is a group commissioned by Sir Bruce Keogh to advise on the commissioning of spinal services. It includes representatives from The British Orthopaedic Association (and associated Spinal Societies including: The British Association of Spine Surgeons, The British Scoliosis Society and The Society for Back Pain Research), The Society of British Neurological Surgeons, The British Pain Society, British Society of Skeletal Radiologists, The Royal College of Surgeons, The Chartered Society of Physiotherapy, The Specialist Orthopaedic Alliance, The Department of Health, Public Health, Specialised Commissioners and the Orthopaedic Expert Working Group that advises on Payment by Results.

For more information please visit the below link:

http://www.nationalspinaltaskforce.co.uk/

Cauda Equina Syndome Online Support Network

The mission of this charity website is to provide support to our fellow CES sufferers. We wanted to create an environment where people understood your concerns and problems, and where sympathy and laughter is a positive shared experience and help in your daily lives.

For more information please visit the below link:

http://www.caudaequinauk.com/welcome.php