Methods

Patients were identified as having sacroiliac joint pain by clinical assessment and positive pain response to local anaesthetic sacroiliac joint lateral branch blocks.

Under fluoroscopic control, the needle is inserted at the lateral edge of the sacral S1-3 posterior foramen. Three lesions at the lateral edge of the foramen are made at 80°C for 90s. A further lesion is made at the L5 dorsal ramus.

Aim

To evaluate the effectiveness of acupuncture in management of common spinal conditions.

Objective

To estimate the frequency of occurrence of the BP in young adults and its relation to the functional state of the spine.

Methods

A before and after design is being used. Patients with disabling pain for more than six months attend a course of six, individual, one hour sessions, integrating mindfulness and acceptance-based exercises with manual therapy. Questionnaire data collected at the course start and after six months, analysed by an independent group, includes pain-related behaviour (Bournemouth Questionnaire), quality of life (EQ5D), self-efficacy (PSEQ) and mindfulness (MAAS).

Background

Perturbation training including bridging exercises and unstable surfaces have been shown to increase trunk activity. Trunk muscle activity increases on the contralateral side to the stabilising leg during bridging, however, no studies exist on the effect of leg dominance on trunk muscle activity during bridging exercises. This study will investigate whether trunk muscle activity differs when stabilising on the dominant versus non-dominant leg.

Methods & Results

71 individuals (30 males, 41 females) with LBP were recruited to the 4-week intervention after screening using the Red Flags and STarT Back tools. Participants were randomly assigned to either the control (standardised care) or intervention group (standardised care plus spinal alignment cushion). Pre and post assessments were taken using the Roland Morris Disability Questionnaire (RMDQ) (0–24), the Core Outcomes Measure Index (COMI) (0–10), and a Pain and Comfort during Sleep VAS Assessment. Each post assessment was analysed using ANCOVA with corresponding pre-assessment as covariate.

Significant differences were seen in the RMDQ in favour of the intervention group (P = 0.034) over the four week period. Significant differences were also seen in favour of the intervention group in the COMI score (P=0.008), the frequency (P=0.004) and intensity of back pain (P=0.000), joint/muscle stiffness (P=0.046) and intensity of back stiffness (P=0.022).

Methods

The lumbar spine was imaged using a positional MRI with participants (n=30) in 6 postures ranging from extension to full flexion. Active shape modelling was used to identify and quantify ‘modes’ of variation in lumbar spine shape. 3D motion capture analysed participants' motion while lifting a box (6–15 kg, self-selected).

Methods

Ten cadaveric vertebral bodies (mean age: 83.7 +/− 10.8 yrs) were scanned using lateral-projection DEXA and Micro-CT. Standardised protocols were used to determine BMD of the whole vertebral body and of anterior/posterior and superior/inferior regions. Vertebral body volume was assessed by water displacement after which specimens were compressed to failure to determine their compressive strength. Specimens were then ashed to determine their bone mineral content (BMC). Parameters were compared using ANOVA and linear regression.

Aim

To explore the usefulness of routine pre-discharge postoperative radiographs in patients undergoing instrumented spinal surgery.

Methods

Sprague-Dawley rats were divided into three experimental groups. In the root constriction group, the left L5 spinal nerve root was ligated proximal to the DRG as a lumbar radiculopathy model. In the root constriction + sympathectomy group, sympathectomy was performed after the root constriction procedure. In the control group, no procedures were performed. In order to evaluate the pain relief effect of sympathectomy, behavioural analysis using mechanical and thermal stimulation was performed. In order to evaluate the excitability of the DRG neurons, we recorded action potentials of the isolated single DRG neuron by the whole-cell patch-clamp method.

Classification systems and their shortcomings

Traditional classifications only looked at curve location (Ponsetti/Friedman); this was enhanced to add curve flexibility (to include or exclude secondary curves in fusion) (PUMC, King/Moe etc). Newer classifications like the Lenke have added sagittal profile into the decision making equation. From 5 basic curve types the subtypes have increased to 42 potential curve patterns by the addition of one parameter!! In future as we understand the 3-D geometry of these curves better we may want to add more measureable items (like degree of rotation) and by adding one term the subtypes would be 128!!! This suggests that we need to have a simple easy to remember way of classifying or eliminate classifications altogether.

Methods

We performed a telephonic survey, contacting every UK spinal deformity centre. The questionnaire probed how each unit compared to the recommended standards.

Null hypothesis

There is no difference in the control of blood loss between 2 drugs.

Method

224 patients' (98 male, 126 female) erect plain lumbar radiographs were reviewed. Lateral plane projections were used to measure the lumbar angle (lordosis), spinous process (SP) height, the interspinous gap (ISG) height, the mid-vertebral body (MVB) height and the mid inter-vertebral disc (MIVD) height of vertebral bodies L1 to L5. The relationship between the heights of these structures and their relative influence and effect on the lumbar angle was investigated using a multiple linear regression model.

Results

SP, ISG, MVB and MIVD heights all had a statistically significant influence on determining the lumbar angle (p < 10⁻³). All heights decreased with age except for the SP height (Graph 1). Age was associated with a decreasing lumbar angle (p 0.134) – (Graph 2). Increasing SP height had an inverse relationship on the lumbar angle. The increase in the SP height had the greatest influence on the lumbar angle (Beta coefficient of -0.71), whilst the MVB and MIVD heights had a lesser influence on determining the lumbar angle (Beta coefficients 0.29 and 0.53 respectively).

Summary of Background Data

Considerable debate exists regarding the pathogenesis, natural history and treatment of Scheuermann's kyphosis. Surgical correction is indicated in the presence of severe kyphosis which carries the risk of neurological complications, persistent back pain and significant cosmetic deformity.

Method

Patients and their parents had a structured interview involving SRS20 and Walter Reed Visual Assessment Scale. The parents were asked to complete an SRS20 as they expected their child to complete it. That is they were asked to anticipate how the child might score and grade the SRS 20.

Results

28 patients, 6 males, 22 females, 8 females were pre-menarche, mean age 14 (12-17), mean cobb angle 57, completed the study. Mean parental age 45. There were 6 fathers and 22 mothers.

The mean SRS scores for the domains for children were pain 2.49, self image 2.3 function 2.9 Mental health 2.9 Total 10.7.

The mean SRS scores for the domains for the parents were pain 2.38 self image 2.39 function 2.97 Mental health 2.87 Total 10.5

There was no significant difference between mean scores for the four domains of the SRS20

Introduction

The Growth rod technique (GR) has been a viable treatment option for progressive early onset scoliosis (EOS). However, an increased complication rate has been associated with conventional GR due to frequent surgeries required for lengthening. The safety and efficacy of a remote-operated magnetic growth rod (RO-MGR) has been previously reported in a porcine model. We are reporting the preliminary clinical results of this device which obviates the need for repeated surgeries.

Methods

Medical records of 30 consecutive patients at an average age of 19(18-24)were reviewed. All patients had segmental fixation with dual rod and pedicle screw construct followed by decortication supplemented with matrix strips/allograft chips. Minimum follow up 1.5 years, average of 2 years (1.5-3). First follow up at 3 months postoperatively and than 6 months subsequently. All patients were evaluated using criteria described by Betz et al for “possible pseudoarthrosis” which included persistent back pain, defects in the fusion mass, loosening of pedicle screws, junctional kyphosis and curve progression of more than 10 degrees from initial standing postoperative PA views.

There were no infections. Average time to clinically and radiographically evident fusion was 12 months (range 10-16). Radiographically visible unfused facet joints were encountered in 3 patients towards the end of the construct. One patient had extension of the construct to treat junctional kyphosis. Other two remained asymptomatic. None had Progression of deformity. One patient developed pars defect at level below construct and was treated with extension of fusion.

Summary of Background Data

Body piercing has become increasingly more common due to change in culture or as a fashion statement. This has been associated with local or generalized ill effects including tissue injury, skin and systemic infections, and septic shock. There is no clear guideline pathway regarding removal and reinsertion of body piercings in patients who undergo major surgery. Complications following Orthopaedic or Spinal procedures associated with body piercing have not been reported.

Methods and results

Medical records of 30 children with spinal deformity treated were evaluated. There were 14 male and 16 female patients at an average age of 4.9 years (1-14) at the time of presentation. These included 18 idiopathic, 11 congenital and a 14 year old with delayed growth having GH treatment. All patients underwent dual growing rod construct using hook and pedicle screw instrumentation. Extensions were carried out at approximately 6 monthly intervals. Average follow up was 4.2 years (2-8.5) with an average of 7.3(3-15) extension/exchange procedures per patient. Average immediate postoperative Cobb angle was 29(15-55) from a preoperative Cobb of 68(55-100) and this was maintained to a final mean Cobb angle of 30(15-60). Average gain in T1-S1 length was 5.7(3.5-9.8) cm. Five patients had final fusion at an average age of 15.5 years.

There were no infections following primary operation. Out of 249 procedures including extensions/exchange, there were 9(4.5%) episodes of deep infection in 7 patients requiring debridement. Four patients (13%) had revisions for rod breakage/screw loosening/hook pullout/junctional kyphosis and three(10%) had prominent implants.

METHODS

A search was conducted in the hospital database between 7^th January 1992 and 29^th December 2010. 73 diagnostic codes were used to identify all scoliosis patients within this period. Repetitions of hospital codes were identified and these represent readmission episodes. Each readmission episode was manually classified using hospital diagnostic/procedural codes, clinic letters, or radiographs. The average costs of the implants used were calculated using the hospital costing database.

Material and methods

The system of internal transpedicular fixation (Vertebra Stabilization System Ø 5.5-6.35, OIM, Turkey) was employed for treatment of 50 patients with scoliosis of various severity. There was 83% of female patients aged from 15 to 23 years. Clinical and radiological methods were used for assessment of treatment results.

Method

400 CT scans were retrospectively reviewed, a classification devised and incidence of abnormalities recorded. 5 types of abnormality were identified. Type 0 is normal; Type 1 describes an asymmetrical shortening of the iliolumbar ligament; Type 2's have the transverse process of L5 within 2 mm of the sacrum but not forming a joint; Type 3's have formed a diarthrodial joint, with 3A's showing no evidence of degeneration and 3B's displaying degenerative changes; In type 4's the transverse process and sacrum have fused; Type5's have involvement of L4. In order to validate the classification, 40 scans were selected with a full cross section of types. 4 independent observers classified each scan in 2 separate sessions, 2 weeks apart.

Summary of Background Data

All pedicle screw constructs have been commonly used to correct adolescent idiopathic scoliosis. There is limited information on their effectiveness in treating patients with cerebral palsy and neuromuscular scoliosis.

Methods and Results

All VCR (n=47) for paediatric spinal deformity were retrospectively evaluated from four university hospitals performing these procedures in Finland between 2005 and 2010. After excluding single hemivertebra (n=25) and resections performed for patients with MMC (n=6), 16 patients with full VCR (mean age at surgery 12.9 yrs [6.5-17.9] AIS 1; NMS 3; Congenital scoliosis 3 primary, revision 4; Kyphosis congenital 2, global 2; NF1 scoliosis 1) were identified. Seven procedures were performed anteroposteriorly and nine posterior-only. Mean follow-up time 1.9 (0.6–5.5) years.

Major Curve (MC) averaged preoperatively 85 (58–120) degrees, 31 (14-53) degrees at 6 months, and 37 (17-80) degrees at 2-year follow-up. MC correction averaged 61 (46-86)% in the AP and 64 (57-83)% in the PL group at 6 months and 54 (18-86)% and 60 (41-70)% at 2-yr FU, respectively (NS). Blood loss averaged 3400 (500-8200) mL (NS between groups). The mean SRS-24 total scores were 100 (92-108) for AP and 102 (95-105) for PL group. There was one paraparesis in the AP group necessitating urgent re-decompression with full recovery. One peripheral L5 motor deficit resolved fully within few days (PL). Two junctional kyphosis were observed (one in both group). One one-sided partial lower instrumentation pull-out was observed without need for revision. One pseudoarthrosis occurred in AP group needing revision.

Methods

281 of 369 patients (22 men) with late onset juvenile (n=67) or adolescent (n=214) braced at mean 24.7 (range 16-32) years previously, responded to follow-up. Patients answered a standardized questionnaire including demographics, work status, Oswestry Disability Index (ODI) (100 - worst possible), EuroQol (EQ-5D) (1 – best possible), and Scoliosis Research Society - 22 (SRS - 22) (5 - best possible), and had radiological examination.

Methods

Cross-sectional cohort study involving 382 rugby playing schoolchildren at three Scottish schools (all male, aged between 12 and 18 years). Outcome measures included maximal isometric neck extension, weight, height, grip strength, cervical range of movement and neck circumference.

Indication

Thoracic kyphosis >55° or back pain and kyphosis >50°.

Background

Pedicle screw misplacement rates with the conventional insertion technique and adequate postoperative CT examination have ranged from 5 to 29 % in the cervical spine, from 3 to 58 % in the thoracic spine, and from 6 to 41% in the lumbosacral region. Despite these relatively high perforation rates, the incidence of reported screw-related complications has remained low. Interestingly, the highest rates of neurovascular injuries have been reported from the lumbosacral spine in up to 17% of the patients. Gertzbein and Robbins introduced a 4-mm “safe zone” in the thoracolumbar spine for medial encroachment, consisting of 2-mm of epidural and 2-mm of subarachnoid space. Later, several authors have found the safety margins to be significantly smaller, suggesting that the “safe zone” thresholds of Gertzbein and Robbins do not apply to the thoracic spine, and seem to be too high even for the lumbar spine. The midthoracic and midcervical spine, as well as the thoracolumbar junction set the highest demands for accuracy in pedicle screw insertion, with no room for either translational or rotational error at e.g. T5 level. Computer assisted pedicle screw insertion (navigation) was introduced in the early 90's to increase the accuracy and safety of pedicle screw insertion.

Aim

To evaluate the performance of a carbonated osteoionductive hydroxyapatite (CHA) scaffold of clinical relevant size (Ø=15mm, H=50mm) in a sheep model of multi level posterolateral intertransverse lumbar spine fusion after activation with autologous bone marrow nuclear cells (BMNC) in a flow perfusion bioreactor.

Summary of Background Data

Thoracolumbar/lumbar scoliosis has been traditionally treated through an anterior approach and instrumented arthrodesis with the aim to include in the fusion the Cobb-to-Cobb levels and preserve distal mobile spinal segments. Posterior instrumentation has been extensively used for thoracic or thoracic and lumbar scoliosis. In the advent of all-pedicle screw constructs there is debate on whether thoracolumbar/lumbar scoliosis is best treated through an anterior or a posterior instrumented arthrodesis.

Objectives

To optimise the radiation doses and image quality for the cone-beam O-arm surgical imaging system in spinal surgery.

Patients and methods

496 patients treated with Boston brace for idiopathic scoliosis were invited for long-term follow-up. 361 women and 29 men responded. Mean age was 39.2 (4.6) years; mean follow-up time 23.4 (4.3) years. 28 patients had been operated. All patients had radiographs at baseline, brace weaning, and follow-up, and filled in validated self-report questionnaires for evaluation of health-related quality of life.

Methods

1440 patients with idiopathic scoliosis were recruited. Information on prevalence of scoliosis among relatives was obtained by questionnaire.

METHODS

8 children with progressive scoliosis due to a variety of conditions, 6 congenital (2 Goldenhar syndrome, 2 VACTERL syndrome, 2 congenital thoracic abnormalities), 1 spondyloepiphyseal dysplasia, 1 early onset of scoliosis, underwent the index procedure and subsequent lengthening procedures at 6 months intervals (1 patient had 11 lengthening procedures).

Mean age was 4 years (2-6 years) and mean follow up 3.8 years (2-6 years). Mean preoperative Cobb angle was 64,8° (51-108) and mean postoperative angle 40° (31-50)

Purpose

In view of the need to better select patients for fusion we investigated the use of the pain drawing (PD) and other potential factors for predicting the outcome of fusion.

Introduction

Few Classification systems for adolescent idiopathic scoliosis (AIS) have helped in communicating, understanding and selecting a treatment for this condition; however, most of these classifications are complex and include many subtypes, making it difficult for the orthopaedic surgeon to use them in clinical practice. The variable reliability and reproducibility of these studies make recommendations and comparisons between various operative treatments a difficult task. Furthermore, none of these classifications has taken the shoulder imbalance into account, despite its importance as a clinical parameter and outcome measure.

Summary of Background Data

Pedicle screw constructs have been extensively used in the treatment of adolescent patients with idiopathic scoliosis. It has been suggested that greater implant density may achieve better deformity correction. However, this can increase the neurological risk related to pedicle screw placement, prolong surgical time and blood loss and result in higher instrumentation cost.

Case

A 14 year old girl without any obvious syndromic feature underwent surgery for a 70 degree thoracic scoliosis. A preoperatively MRI showed a dural ectasia. A preoperative low dose–CT revealed dystrophic pedicles from Th4 to L4, making transpedicular screw placement problematical.

The operation was performed with the aid of an O-arm. At all levels from Th2 – L2 laminar screw fixation was used.

Postoperatively, low-dose CT showed excellent screw positioning with the exceptiuon of one proximal screw which compromised a foramem but, without any symptoms.

The postoperative course was quite uneventful and the patient was discharged at day 5days postoperatively. The correction rate was 70%.

Conclusion

In cases of scoliosis with severe dystrophic pedicles, the use of laminar screws is a good alternative to problematic transpedicular screw placement.

Methods and Results

Retrospective review of 50 consecutive adult scoliosis patients treated using anterior only(14,28%), posterior only(19,38%) or combined(17,34%) approaches. All patients were anaesthetised by the same anaesthetist implementing a standard protocol using cell salvage, controlled hypotension and antifibrinolytics.

Mean age was 24.6 years. BMI was 21.9. On an average 9.5(6-15) levels were fused, with an average duration of surgery of 284.6(130-550) minutes. Antifibrinolytics were used in 31(62%) of the patients which included Aprotinin in 21(42%) and Tranexamic acid in 10(20%). Patients on antifibrinolytics had a significantly (p<0.05) lower blood loss (530ml) as compared to other patients (672ml). Mean volume of the cell saved blood re-transfused was 693.8 ml and mean postoperative HB level dropped to 10.7 g/dl(7.7-15) from a mean preoperative of 13.3 g/dl(10-17).

7(42%) with combined approaches and 3(15.8%) with posterior only approach required blood transfusion, 4/50(8%) of which required intra while 6/50(12%) required intra and postoperative transfusion. None of the patients having anterior surgery alone required blood transfusion.

CONCLUSION

What are the risks with aneurysma at spinal correction? Should the correction have been performed without the aortic stent?

METHODS

6 children with progressive scoliosis (2 severe cerebral palsy, 2 congenital cyanotic heart disease, 1 Worster Drought syndrome, 1 Leigh's disease), underwent a serial and limited exposure of the lower and then the upper end of the spine, and insertion of pedicle screws, hooks and clamps. Two submuscularly rods were connected and distracted.

Mean age was 13 years old, the mean preoperatively Cobb angle was 87° and the mean postoperatively Cobb angle was 62°. The mean operation time was 120 min and the peri-operative blood loss was 410 ml. Mean follow up is 15 months.

Patients and Methods

Seventy-nine patients, who had undergone PLIF procedure using HMA screws supplemented by pedicle screw fixation, were included. Patients deemed suitable for surgery following discography under sedation, with Marcaine instillation establishing reducibility of the listhesis and temporary relief of symptoms. Clinical outcome included visual analogue scale scores for leg pain and back pain, Oswestry Disability Index (ODI) and SF-36 questionnaires.

Methods

We compared nine girls with left-thoracic AIS (mean age 14 years; mean Cobb angle 19°) with 11 matched controls, and 20 girls with right-thoracic AIS (mean age 15 years, mean Cobb angle 33·8°) with 17 matched controls. The statistical brain analysis was done with validated automatic segmentation and voxel-based morphometry (VBM). The T2W-MRI data for shape analysis of the vestibular system were obtained from 20 patients with right-thoracic AIS and 20 matched controls. A best-fit plane and a best-fit circle were calculated to approximate each semicircular canal. The shape of vestibular system was measured by: (1) the angle between each pair of best-fit planes; (2) the length; and (3) angle formed between the corresponding lines connecting the centres of each pair of circles. Statistical analysis was done with one-way ANOVA.

Methods

At our institution, more than 6900 patients aged 1–89 years have undergone inpatient and outpatient treatment in connection with spinal pain syndrome and different neurological disorders associated with idiopathic scoliosis. This study was undertaken between February, 1996, and February, 2010. All patients had had clinical, radiographic, and laboratory examinations.

Method

63 patients with non-specific LBP, with or without leg pain, were randomised to three treatment groups. MR images of paraspinal muscle and the atrophy classified. A-Control group, standard physiotherapy for 10 weeks. B-Multifidus rehabilitation program for 10 weeks. C-Perifacet injection (multifidus injection) with methylprednisolone.

ODI was primary outcome measure and the SF-36, modified Zung Depression Index and others were secondary outcome measures.

Background

Anjarwalla et al. have shown that the addition of posterior pedicle supplementation without posterolateral fusion during an ALIF procedure significantly increases the rate of interbody fusion when using a carbon fibre / PEEK cage packed with autogenous iliac crest graft. Stand alone ALIF cages which utilise screws passing through the interbody cage and into the vertebral bodies were designed to obviate the need for a posterior procedure by increasing the anterior construct stability and fusion rate.

Methods

Family members of 513 Chinese patients with AIS attending a scoliosis clinic were assessed. A diagnosis of AIS was made with the criteria of Cobb angle greater than 20°. The evaluation included clinical assessment and physical examination in a health screening centre by medical doctors with use of forward bending test. Any positive screening cases were referred to a scoliosis clinic for follow-up spinal radiograph. All radiographs were assessed by an orthopaedic surgeon in the scoliosis clinic. A population prevalence of scoliosis was obtained from the data of a territory-wide screening campaign. The prevalence of AIS among siblings of probands was measured both overall and divided by sex of siblings. The sibling recurrent risk (λs) was calculated for male and female siblings separately with reported population incidence of AIS.

Methods

879 white individuals with AIS severe spine curvatures and 1486 white controls were evaluated for CNVs with the Affymetrix 6.0 HUSNP array. After implementation of quality filters, data were quantile normalised. Copy number analysis was done with Helix Tree (Golden Helix, Bozeman, MT, USA). The copy number segments were measured with the Golden Helix's univariate segmentation algorithm. Statistically different segments were extracted with mean Log2 ratio intensity for that segment to highlight deletions, neutrals, and duplications. We then undertook association analysis on those segments. A p value of less than 10–7 was regarded as significant.

Methods

We tested more than 327 000 single-nucleotide polymorphisms (SNPs) across all human autosomes for association with disease.

Methods

Osteoblasts isolated from patients with AIS were selected for each functional subgroup and compared with osteoblasts obtained from healthy matched controls. We used the latest gene chip human genome array Affymetrix (HuU133 Plus 2.0 array) that allows for the analysis of the expression level of 38 000 well characterised human genes. Raw data were normalised with robust multiarray analysis method. Statistical analysis was done by the EB method with FlexArray software. Selection criteria for in-depth analysis include the magnitude of change in expression (at least □} 3-fold) and 5% false discovery rate as stringency selection. Validation of selected candidate genes was done by qPCR and at the protein level by Western blot and ELISA methods. Plasma OPN concentrations were measured by ELISA on a group of 683 consecutive patients with AIS and were compared with 262 healthy controls and 178 asymptomatic offspring, born from at least one scoliotic parent, and thus considered at risk of developing the disorder. The regulation of OPN signalling pathway in normal and AIS cells were validated in vitro by cellular dielectric spectroscopy (CDS).

Methods

Of 181 consecutive patients with MFS with known causative fibrillin-1 mutations, 93 were male (51%) and 88 female (49%). 28 (15%; ten males, 18 females) of the total group had moderate to severe scoliosis, including two females and two males who had corrective surgery. Of the 16 patients with severe scoliosis (three males, 13 females), FBN1 mutations clustered in the latter half of the gene in exons 33–63. Of these 16 mutations, ten were severe (seven stop codons, three splice site mutations); the others were point mutations, three involving added cysteine and three substituted cysteine, in calcium-binding EGF-like regions.

Height A rapid adolescent growth spurt to excessive height is a documented clinical feature in MFS. The age of clinical diagnosis as an indication of severity was on average 11·3 years (range 2 days to 36 years), and ten patients were diagnosed before the age of 12 years.

Methods

40 newly hatched broiler chickens were divided randomly into four equal groups: sham-operated chickens serving as control (CNT); pinealectomised chickens (PNX); and sham-operated (CNT+MLT) and pinealectomized chickens (PNX+MLT) that received intraperitoneal administration of MLT (8 mg/kg) at 2200 h daily. Pinealectomies were done at the age of 3 days. Before killing the chickens at 2 months of age, blood samples were collected at midnight and MLT concentrations were measured by radioimmunoassay. Post-mortem radiographs were examined for the presence of scoliosis, and microcomputed tomography (micro-CT) images were taken to assess the microstructure of the cervical vertebrae. Histological specimens of the scanned cervical vertebra were prepared, and a mid-sagittal section was stained with haematoxylin and eosin (HE) and tartrate-resistant acid phosphatase (TRAP) to assess the numbers of osteoblasts and osteoclasts, respectively.

Methods

Distraction forces were measured prospectively during 60 consecutive lengthening procedures in 26 patients. All patients had single submuscular rod constructs with side-to-side connectors. For every measurement, output from a transducer on a dedicated pair of distraction calipers was recorded at zero load status, and the force was then recorded at every 1 mm lengthening; length was obtained at each event and was recorded in millimeters.

Methods

Standing, lateral radiographs of 82 untreated patients with EOS with Cobb angle greater than 50° were evaluated. Sagittal spine parameters (sagittal balance, thoracic kyphosis [TK], lumbar lordosis [LL]) and sagittal pelvic parameters (pelvic incidence [PI], pelvic tilt [PT], sacral slope [SS], and modified pelvic radius angle [PR]) were measured. These results were compared with those reported by Mac-Thiong and colleagues (Spine, 2004) for a group of similar aged children without spinal deformity.

Methods

Ten patients with TIS underwent dynamic lung MRI testing as part of the routine clinical preoperative work-up. Each hemithorax was graded: 1=intact motion of both chest wall and diaphragm; 2=primarily loss of chest-wall motion with minimal diaphragm abnormality; 3=substantial loss of diaphragm excursion with minimal loss or compensatory hyperkinesis of chest wall; and 4=substantial loss of both diaphragm and chest-wall motion. The grades for each hemithorax were added and averaged to form the thoracic function score. Ranges of scores were grouped into levels of clinical thoracic performance: level I (score 1–1·5); level II (>1·5–2·5); level III (>2·5–3·5); and level IV(>3·5–4·0).

Materials and Methods

We included in our study 100 patients who underwent ACDR in our Spinal Unit (between May 2006 – May 2010). We used as clinical outcome measures: Visual Analogue Score for neck pain (VAS-NP) and arm pain (VAS-AP), Neck Disability Index (NDI) and Bodily Pain (SF36-BP) component of the Short Form 36 questionnaire. Statistics were obtained using SPSS 16.0 for Windows (SPSS Inc, Chicago, IL). Independent sample t-test for normally distributed data and Man-Whitney U test for non-parametric data were used. Statistical significance was designated at p < 0.05.

Methods

Fifty patients with single-level, symptomatic lumbar DDD between L4 and S1 were enrolled in a clinical trial of a VTDR across three surgical centres. A comprehensive, independent review and statistical analysis of both clinical and radiographic outcomes was performed and analyzed for correlations. Data from preoperative through 2 years were available. The COR was calculated for the index levels and compared to data for an asymptomatic population. Each COR coordinate was classified as abnormal if outside of the 95% confidence interval for an asymptomatic population.

Methods

53 girls with AIS and 27 healthy girls (aged 11–16 years) were recruited in this preliminary study. Clinical and anthropometric data were obtained. Blood samples were obtained for ELISA of leptin and soluble leptin receptor (sOB-R). Independent Student's t test and multivariate regression were used in group comparison.

Methods

Data was collected prospectively. The study population comprised 200 patients. 19 patients who sustained dural tears (Group A) were compared to a control group of 181 patients with no tear (Group B). Outcomes were measured with the SF-36, Oswestry Disability Index (ODI) and visual analogue scores for back (VB) and leg (VL) pain. Scores for the 2 groups were compared pre-operatively, at 2 and 6 months post-op for all patients and at long-term follow-up (range 2-9 years) for patients in group A.

In addition for patients in group A the patients satisfaction with the procedure, ongoing symptoms, employment status and analgesic intake were documented.

Methods

After induction of general anaesthesia, the patient is placed prone and the pedicle of interest is identified using fluoroscopy. A ‘K’ wire is then inserted percutaneously into this pedicle under image guidance (confirmed in the antero-posterior (AP) and lateral views). The ‘K’ wire is then cut flush and the patient is then positioned laterally and the intended procedure is performed.

Material and Methods

Retrospective review of patients with L5/S1 stand-alone anterior interbody fusion, focussing on screw length, radiological outcomes (especially metal work failure, screw fixation and S1 body fractures) and new onset of S1 nerve root irritation.

Hpothesis

Load is normally transferred across the arch in axial rotation. Bifid arch results in increased strain across the isthmus of the loaded inferior articular process.

Methods

Patients were entered prospectively and followed up at 6 weeks, 3, 6, and 12 months and annually thereafter. Plain radiographs were obtained annually. 58 patients who underwent Dynesys stabilisation with HA coated screws (312 screws) were evaluated. The data was compared with 71 patients who underwent Dynesys stabilisation with non-coated pedicle screws (366 screws). Outcome measures were screw loosening, breakage, implant removal or revision. Follow up was 96 %.

Methods

Data from vertebrae and corresponding ribs were collected. Data included 46 measurements from the vertebral body and ribs at T1, T4, T7, T10, and L3. Measurements were obtained with Vernier calipers, tape measures, and photographs of each bone. Several specimens were digitised with a Next Engine 3D laser scanner. The initial analysis used caliper-derived data, with some measurements obtained from photographs. The data were analysed by age, specific bone, and morphological features. More than 2000 cross correlations were studied. Linear regressions were done on scalar measurements with SAS (version 9.1.3) and JMP (version 8.0). Although the general demographics for each child were known, specifics such as height and weight or previous trauma were not.

Methods

This study is a retrospective, clinical and radiological analysis of seven consecutive children aged 1–2 years treated with anterior vertebral instrumentation and fusion by downsized rod screw systems. The mean age at time of surgery was 2 years 4 months (range 1 year 9 months to 2 years 10 months). The average follow-up period was 3 years 3 months (2 years 6 months to 4 years 5 months). 16 screws inserted anteriorely were evaluated by a follow-up CT scan. Spinal canals were divided with known anatomical landmarks into right and left hemicanals. The relation of the anterior screws to the NCC and the spinal canal dimension were studied. All clinical and radiological complications were recorded.

Objectives

To analyse the possibility, safety and efficacy of cervical pedicle screw insertion in complex pediatric cervical deformities, where conventional stabilisation techniques would not have provided rigid fixation.

Methods

A retrospective review of consecutive CNRB procedures carried out between January 2008 and June 2010. All procedures were performed using a combination of local anaesthetic and steroid under fluoroscopic guidance. The inclusion criteria were brachialgia with MRI proven nerve compression and inadequate response to physiotherapy. Patients that underwent both a CNRB and facet joint injections were excluded. The outcome measures assessed were the response gained (complete/temporary/no relief) and the choice of further management.

Introduction

The administration of local steroids and other drugs into caudal epidural space has been well established procedure in the management of low back pain with or without leg symptoms. Various studies have been done to assess the efficacy of the different routes of administration of epidural injections. However, only a few published prospective studies have been done on performing caudal epidural injections under fluoroscopic guidance with validated outcome measures.

Method

In the prone position, two contoured hard rods are passed along the inner table of the pelvis under the iliac muscle from a minor posterior approach. The rods are connected to the posterior lumbo-pelvic construct with T-junction clamps. The patient is turned supine and the anterior ends of the rods are connected to a sub-cutaneously placed hard rod along the anterior abdominal wall with T-junction clamps. This in turn is fixed to the AIIS (anterior inferior iliac spine) with two poly axial screws. The whole construct resembles an oblong ring.

Materials and Methods

Sheffield Spinal Infection Database collects data prospectively from regularly held Spinal infection MDTs. We accrued 125 spinal infections between September 2008 and October 2010. The medical records, blood results, radiology and bacteriology results of all patients identified were reviewed. In patients with negative first biopsy, second biopsy is contemplated and parenteral broad spectrum antibiotic treatment initiated.

Methods

77 patients with AIS underwent surgery (range 6–15 levels). 35 patients received CMSS, which was characterised as bilateral screw fixation at every level. 42 patients underwent ALSS, which entailed bilateral screw fixation at alternate levels. Titanium rods were used in all cases. Preoperative and postoperative posteroanterior and fulcrum bending radiographic Cobb angles were obtained for all patients. The fulcrum flexibility and the fulcrum bending correction index (FBCI) were assessed. Cost analysis was also done.

Methods

Nineteen healthy volunteers (12 female, 7 male) were recruited to the study. Collars were fitted by an approved physiotherapist. Eight ProReflex (Qualisys, Sweden) infra-red cameras were used to track the movement of retro reflective marker clusters placed in predetermined positions on the head and trunk. 3D kinematic data was collected during forward flexion, extension, lateral bending and axial rotation from uncollared and collared subjects. The physiological range of motion in the three planes was analysed using the Qualisys Track Manager system.

Methods

We have investigated the localisation of elastic proteins in different spinal tissues at different stages of curve development in mouse models and in human tissue obtained during scoliosis surgery.

Methods

The clinical notes and Magnetic Resonance Imaging (MRI) results of patients presenting to the Sheffield Spinal Service with Thoracic spine symptoms but no signs were retrospectively reviewed over the period of 2 year (September 2008-August 2010).

The clinical reason for request of Thoracic MRIs were noted and the patient notes were reviewed to determine their presentation, length of time of symptoms, age and also it was noted whether any other recognized red flag symptoms were present. Exclusion criteria consisted of patients referred with known SSP or myelopathic symptoms.

Methods

Our study group consists of Adolescent Idiopathic Scoliosis patients who presented consecutively in our institution from June to September 2010. They were either seen in outpatient clinics or as elective admissions prior to operative correction of their spinal deformity. The presence of an idiopathic scoliosis deformity and the absence of any abnormal neurological symptoms were our inclusion criteria. They were examined by two clinicians for the presence of IRR using a tendon hammer. As part of their management all such patients routinely undergo an MRI scan in our Trust to investigate for the presence of intraspinal pathology. When the IRR was present we looked at their MRI scans to identify any relevant abnormalities.

Results: We identified 100 subjects. There were 72 females and 28 males with an average age of 15 years. The IRR was present in 12 cases and in 6 of them the sign was present bilaterally. There were no further associated signs or symptoms. All cases had recently undergone MRI of their whole spine and their investigations did not demonstrate any abnormalities in the lower cervical spine.

Methods

445 patients (323 women, mean age 21 years; 122 men, mean age 24 years) with instability, imbalance, and spatial disorientation were submitted to T2 MRI modelling. 95 of 445 patients had scoliosis: 57 thoracolumbar scoliosis, 24 thoracic scoliosis, and 14 lumbar deformation. We processed the data acquired with G.E.MRI (1.5T), T2- 3D Fiesta with a set of Brainvisa modules (http://brainvisa.info/).

Materials and Methods

Between 1980 and 2009, nine histologically confirmed cases of primary conventional osteogenic sarcoma of the spine were identified from Scottish Bone Tumour Registry. This prospectively collected registry database was retrospectively reviewed.

Methods

We evaluated a cohort of 19 patients, all of whom were girls with a mean age of 14·7 years (range 13–18) with right idiopathic thoracic curve (mean Cobb angle 53·5°, range 37–72°; of the apical vertebra from T7 to T9). Heart and pulmonary functions were evaluated by heart ECHO and spiroergometry.

Methods

Retrospective analysis from a comprehensive spinal oncology database.

Methods

A consecutive series of 143 patients with AIS (Lenke classification 1–4) surgically treated from 1998 to 2005 by means of thoracic pedicle screws were retrospectively reviewed. Considering implant density (number of fixation anchors placed per available anchors sites; segmental =60% [S], non-segmental =60% [NS]) and implant alloy used (titanium [Ti] vs stainless steel [SS]) we divided the cohort into four groups: Ti-S (48 cases); Ti-NS (34 cases); SS-S (35 cases); and SS-NS (26 cases). Groups were similar for preoperative mean age, sex distribution, Risser sign, main thoracic curve, and thoracic kyphosis. Pearson correlation coefficient and univariate analysis of variance were used.

Aim

To assess if patients treated within half of the maximum recommended time for surgical decompression following cauda equina i.e 12 hours, are still pre-disposed to persisting neurological compromise.

Materials and Methods

Retrospective review of 12 patients (8 female and 4 male), mean age 65.5±4.9 years, treated with anterior fusion mainly for degenerative scoliosis and lumbar kyphosis in between 2007-10. 9(75%) patients had multilevel procedures. Most common co-morbidities were atherosclerosis (CT-proven in 7 patients), coronary heart disease and COPD. Renal impairment was present preoperatively in 3 patients.

Methodology and Results

36 patients with radiculopathy/myelopathy, who failed to respond to conservative measures, were included. Pain and function were evaluated by Visual Analogue score for Neck pain (VAS-NP) and Arm pain (VAS-AP), Neck disability index (NDI) and SF-36 questionnaires. Radiological assessments include assessing overall range of movement (ROM) and at functional segment unit (FSU). Statistical analysis was completed using SPSS 16.0 statistical package (SPSS Inc, Chicago, IL). Appropriate parametric (A paired t-test) and non parametric tests (Wilcoxon signed-rank test) were used to assess the statistical significance (p<0.05).

The average age at operation was 51 years (range 35 - 77years). 8 patients received ACDR at one-level, 15 had 2-level surgery, 12 had 3-level surgery and 1 had a 4-level surgery. At the time of final follow-up (Mean 14.25 months, Range 12- 22.5 months) the mean NDI improved from 49.35; to 33.78 (p< 0.001). There statistically significant improvement note in VAS-NP (Post-op3.65, Pre-op:8.16, p<0.001), VAS-AP (Post-op:3.12, Pre-op:7.32, p<0.001) and SF-36BP (pre-op:29.15, post-op:37.18, p<0.002). The overall global ROM movement was preserved (pre-op:46.80±10.52, post-op:45.04±11.53) and an improvement in ROM at FSU was observed (pre-op:16.60±8.50, post-op:20.22±12.22) at final follow–up.

Introduction

The principle of radiotherapy is to deliver a high dose, accurately, to the tumour. Conventional photon and proton therapy irradiates adjacent tissue significantly. This is reduced with intensity modulated proton therapy (IMPT). This has been demonstrably effective in treating tumours refractory to chemotherapy and conventional radiotherapy such as chrondrosarcomas and chordomas

Methods and Results

LexisNexisTM Professional search engine was utilised to retrieve articles from all national newspapers over a six months containing the terms “back pain/backpain/back ache/backache” from May to October 2009.

284 relevant articles were retrieved. Of these tabloids accounted for 62% and broadsheets for 38%. Back pain was the sole topic in 7%, a main topic in 18% and mentioned in passing in 75%. 15% were essentially case reports and the tone was neutral in 95%, positive in 2.5% and negative in 2.5%. The cause of back pain was mentioned in 11% of articles- trauma accounted for 50% and disc disease and spinal deformity for 20% each. Only 0.3% of articles discussed litigation. Articles mentioned new physiotherapy regimes in 7%, new forms of alternative therapy in 7%, new surgical techniques/technologies in 2% and new medications in 1%. They were significantly more likely to mention new non-surgical techniques- Fishers' Exact Test p=0.01. Articles were alternative therapy related in 3%, physiotherapist related in 2%, surgeon related in 1% and pain specialist related in 1%. 10% of papers included a quote from an “expert” of which 23% were Spine Surgeons, 16% GP's, 13% Sports Physicians, 13% alternative therapists, 10% pain specialists and 7% physiotherapists. Overall, 98% of articles were of a neutral tone and 1% were of a positive tone or negative tone. Articles concerning physiotherapists or new surgical techniques/technologies were significantly more likely to be of a positive overall tone than the other articles- Fishers' Exact Test p=0.04.

Methods and Results

All patients who received radiotherapy for metastatic spinal cord compression from 1^st June 2009 – 1^st June 2010 were identified. This information was then compared to the data collected via the MSCC Coordinator. The notes and radiological investigations were reviewed by the spinal consultant.

34 patients received radiotherapy for MSCC, 15 patients were not referred to the spinal team prior to radiotherapy. On reviewing each individual case 2 patients may have potentially benefited from surgical intervention.

Methods and Results

We performed 138 percutaneous balloon kyphoplasty procedures in 85 patients during august 2007 to march 2010. Gender distribution was 25 males and 60 females. Age distribution was 33 to 85 years, with an average age of 67.4 years.

The senior surgeon attempted vertebral biopsy during percutaneous balloon kyphoplasty procedure only when there was a clinical/operative suspicion of malignancy. We did not routinely biopsy all vertebrae, as this would mean additional procedure adding to the cost and operating time.

In 42 procedures vertebral biopsy was attempted, of which 5 samples were reported as insufficient specimen. 37 biopsies (88%) were successfully analyzed. 3 biopsies (8.1%) were positive for malignancy. There were no complications encountered in the cases where additional biopsy procedure was carried out.

Methods

A large multiplex AIS French family was chosen for this study on the basis of clinical and radiological data. Whole genome genotyping of the 20 members of this family led to the mapping of a dominant disease-causing gene to two critical genomic intervals (Edery and colleagues, Eur J Hum Genet, accepted [2011]), but the causative mutation remains to be identified. In parallel, gene expression profiling was investigated by microarray analysis in RNA samples isolated from osteoblasts derived from healthy individuals and those with AIS. RNA samples were extracted from osteoblasts, purified, fluorescently labelled, and then hybridised to gene expression microarrays with the Illumina expression BeadChips technology containing more than 46 000 probes for the human genome (HumanHT-12). Data analysis in R version 2.10.1 (Bioconductor packages oligo and limma) was done, and genes that had at least 1·5-fold change in expression were considered differentially regulated relative to controls. AIS candidate genes within the critical intervals were selected on the basis of their mRNA expression in AIS individuals and by their known functions. The coding regions of these candidate genes were then sequenced to identify potential mutations. The biological activity of mutant proteins is under evaluation by in-vivo functional studies in zebrafish.

Methods

20 female, 3-week-old C57BL/6 mice underwent amputations of forelimbs and tails at 3 weeks, 18 of which were included in analyses. Posteroanterior scoliosis radiographs were obtained at week 20, and scoliotic curves were recorded. After week 20, all mice received 10 mg TMX per L of daily water supply for 20 weeks. The course of deformities in this group (week 20 group) was compared with that of previous study groups (receiving TMX from week 3; week 3 group).

Methods and Results

We performed 138 Balloon kyphoplasty procedures in 85 patients during august 2007 to march 2010. Data was collected and analyzed in all these cases. Gender distribution was 60 females and 25 males. Age distribution was 33 to 85 years, with an average age of 67.4 years. Indications of surgery were vertebral fractures due to osteoporosis in 81% of the procedures, trauma in 13% and malignancy in 6%. The most common vertebral levels of the kyphoplasty were at T12 in 32 procedures (23%) and L1 in 28 procedures (20%). Eggshell technique was introduced in 2009 where technical problems were encountered during cementing process.

All patients had reduced pain levels, which was assessed by visual analog score. The average length of hospital stay was 2.5 days. Complications were 9 (6.5%) cement leaks (all within one cm from the vertebral body) in procedures performed before the introduction of eggshell technique and no cement leak following the introduction of eggshell technique, 5 (3.6%) fresh fractures, 2 (1.4%) intra-operative fractures and 1 (0.73%) rupture of balloon. There were no complications of cord compression, motor deficit, infection, allergy to cement or pulmonary embolism noted. 30-day mortality rate was zero.

Methods

Measurements were taken from 20 patients with AIS treated between June, 2009, and January, 2010. There were 16 female and 4 male patients with an average age of 14.2 years (range 11–20); the coronal preoperative Cobb angle was 67° (42–108°), decreasing on bending to 39° (8–83°), and the apex of the deformity was between T6 and L2. All patients had proximal and distal anchors spanning two levels on each end; the anchors were connected by a concave rod to which the apical vertebra was pulled. We measured the distance between the rod and the apical vertebra and the rotation of the apical vertebrae.

Methods

All AIS cases, surgically treated between 2002 and 2008 in our institute, were reviewed. Inclusion criteria were: patients with Lenke 1C scoliosis treated with posterior pedicle-screw-only constructs; the lowest instrumented vertebra (LIV) ended at L1 level or above; and a minimum 2-year radiographic follow-up. Standing anteroposterior (AP) and lateral digital radiographs from different timepoints (preoperative, immediately postoperative, 3 months postoperative, and final follow-up) were reviewed. In each standing AP radiograph, centre sacral vertical line (CSVL) was drawn first, followed by measurement of the translation (deviation from the CSVL) of some key vertebrae, such as the LIV, LIV+1 (the first vertebra below LIV), LIV+2 (the second vertebra below LIV), LIV+3 (the third vertebra below LIV), lumbar apical vertebra, thoracic apical vertebra, and T1. Additionally, the Cobb angles of major thoracic and lumbar curve were measured at different timepoints, and the correction rate was calculated. Furthermore, clinical photos of patients' back appearance were taken preoperatively and postoperatively.

Methods

30 patients with degenerative spondylolisthesis (DS) were consecutively managed by a single consultant spinal surgeon. All patients presented with neurogenic claudication secondary to DS. All patients were managed operatively with lumbar decompression utilising an approach technique of “spinous process osteotomy” (1). Briefly, this approach requires only unilateral muscle stripping with preservation of the interspinous ligament. A standard centrolateral decompression is then performed. Data consisting of VAS back and leg pain and ODI were collected pre and post-operatively.

Methods

We evaluated samples taken from 12 patients with idiopathic scoliotic deformities and a control set of three patients without scoliotic deformity. We examined the samples of autonomic nerves taken from convexity and concavity of the scoliotic deformity during the patients' surgical correction by the transthoracic approach. We used the electronmicroscopic method to analyse samples, and the morphometric method for statistical evaluation.