Case Studies

Professor Adrian Gardner BM PhD MRCS FRCS(T+O)

Consultant Spine Surgeon

The Royal Orthopaedic Hospital and Birmingham Women’s and Children’s Hospital

1.Health technology assessment application for night-time versus daytime bracing in scoliosis.

This HTA commissioned call was to investigate, in a pragmatic trial setting, the use of an overbending night-time brace against standards of care (full-time bracing).

As a scoliosis surgeon this was something that I felt I could take forwards and worked with BCTU to develop a stage one application. I was supporting NBC to you with a trial manager and statistician and developed a team of Co-applicants for the application.

Unfortunately, we were not selected to go forward to the stage two application. I have subsequently been successful as a co-applicant to the Application that was funded led by Ashley Cole, a scoliosis surgeon from Sheffield.

The feedback to our application suggested that we were too expensive and in hindsight we could have been a little more appreciative of the standard of care costs for the routine brace.

2.Health technology assessment Application for the use of a rigid collar versus no collar for odontoid peg fractures in the elderly.

This was a commissioned HTA call to investigate whether it was appropriate to use a rigid, when compared to the use of no immobilisation in odontoid peg fractures in an elderly population.

This is a pathology that I treat as a spinal surgeon in the West Midlands. I put together an application at stage one with the assistance of BCTU in conjunction with Professor Tony Belli from the University Birmingham.

This application at stage one was successful, and I was asked to apply further at stage two. Unfortunately, following the stage two application and questions from reviewers, I was ultimately unsuccessful. The trial was funded to a group from Edinburgh. The feedback was that the stage two application from Edinburgh was preferred to ours from Birmingham. I am now a site principal investigator for the Royal Orthopaedic Hospital for this study from Edinburgh. Having seen the Edinburgh protocol, there is very little difference between both their trial and our application.

Learning Points

In both of these applications I have taken away a number of learning points. The application for this sort of funding is most definitely a team event. As a surgeon, which is mostly a solo event, this was something that I was not used to. Most definitely the things I have taken forward to more recent applications are around building a team early, exploring options and developing a plan acceptable to all of the team members and being realistic about what can and cannot be achieved. It is obviously disappointing not to have been funded, however, I certainly feel in a stronger place for future work.