Idiopathic scoliosis is a spine disorder of unknown origin with a prevalence of 1·5-3% in the general population. Apart from the large multifactorial form sample of idiopathic scoliosis, there is a good evidence for the existence of a monogenic subgroup in which the disease is inherited in a dominant manner. However, results from published work suggest a strong heterogeneity in locations of the mutated genes. With a high resolution genome-wide scan, we undertook linkage analyses in three large multigenerational families with idiopathic scoliosis compatible with dominant inheritance, including 11–12 affected members or obligate carriers.Introduction
Methods
Atlanto-occipital dislocation is rare and usually fatal. Stabilisation is typically from Occiput to C2, sacrificing atlanto-axial movement. To preserve movement, screw fixation from the articular mass of C1 to the occipital condyle has been described. Amongst other structures, the hypoglossal nerve is at risk. No previous study has addressed the anatomy of the hypoglossal canal in relation to screw trajectory. We aim to identify landmarks to aid safe screw passage into the occipital condyle. 20 dry skulls provided 40 hypoglossal canals (HCs) and 40 occipital condyles (OCs). No distinction was made between sex, race or age. 9 parameters were measured for each HC, and relation to skull base was noted.Introduction
Methods
The SF 36 questionnaire has been validated and used in multiple studies. However, it remains unclear how well patients complete the SF-36 questionnaire in a spinal outpatient clinic setting outside the context of a study. We aim to assess the quality of information gained if the SF 36 is used as an audit and outcome measure in real clinical practice. The SF 36 has been used in our clinic as a routine for the initial assessment and outcome audit of patients for the last 4 years. A prospective, consecutive sample of 85 patients’ SF-36 forms was evaluated during a spinal out-patient clinic over one month at our teaching hospital. Completeness of data entry was assessed. All patients had access to a translator and clinic nurse to help complete the questionnaire if needed. There were 34 males and 51 females (age range 16 to 81, average 48). Thirty seven patients were White British, 22 other and 26 undisclosed ethnicities. Thirty eight (45%) forms were complete leaving 47 (55%) which had at least one question unanswered or spoiled. Of these, two had five to ten errors, one had 10 to 15 errors, four had 15 to 20 errors, seven had 20 to 25 errors, ten had 25 to 30 errors and 17 had 30 to 35 errors. In addition six forms were entirely incomplete beyond patient identifier information. White British patients had fewer errors (average 4) compared to other (9) and unknown (9) ethnicities. Outside the context of a research study, the SF-36 questionnaire in an urban teaching hospital spinal outpatient clinic is not a reliable tool. Redesign of the questionnaire may be required. The SF-36 questionnaire is less well completed by patients declared as non White British, even with the facility for a clinic nurse and a translator.
The aim of the study was to assess the safety of a novel anatomical landmark in the placement of thoracic pedicle screws. It is our clinical observation that the sagittal plane of the screw trajectory is perpendicular to the plane of the superior articular facet, when the entry point is in the lateral half of the articular surface of the corresponding superior facet. Using SECTRA software on a PACS digital imaging system, morphometric analysis was performed on thoracic vertebrae imaged using computed tomography (CT). For inclusion, the scan had to have no reported bony abnormality. It was determined whether a trajectory as described at 90 degrees to the articular facet, with an entry point just caudal to the lateral half of the facet to a depth of 25mm would breach either the medial wall of the pedicle or lateral vertebral body wall anterior to the costovertebral facet. Sixty-two CT scans (744 segments, 1488 pedicle-facet complexes) were reviewed. 1154 complexes were suitable for full analysis. Exclusions were due to the lumbarisation of the T12 facet joints (62) or inability to clearly define the facet surface due to the plane of the CT slice (272). Of 1154 entry points assessed, 1154 (100%) were safe to be entered at 90 degrees to a depth of at least 25mm. We have demonstrated the safety and reliability of a novel anatomical landmark in normal thoracic pedicles. We believe this will improve sagittal plane alignment and reduce further the risk of medial pedicle breach.
Acute osteoporotic vertebral compression fractures (VCFs) are frequently misdiagnosed as there is often no history of preceding trauma. VCFs not only cause back pain, but can also result in a loss of function, spinal deformity and increased mortality. Cement augmentation has been shown to effectively treat these fractures. It is impossible to diagnose an acute fracture on plain x-ray and therefore identify those likely to benefit from this treatment. The definitive investigation to determine the presence of an acute fracture is a MR scan, but this is a limited resource. The aim of this paper is to evaluate 2 new clinical signs which we believe aid in the diagnosis of an acute VCF: firstly closed fist percussion at the level of an acute VCF resulting in a severe, sharp fracture pain, and secondly the inability of a patient to lie supine. This was a prospective study of 78 patients with suspected acute VCFs. 48/78 had an acute fracture on MR. 42/45 patients who were positive for closed fist percussion, had an acute fracture on their MR scan. There were 6 patients who were negative for closed fist percussion who had an acute fracture (sensitivity 87.5%, specificity 90%). 39/41 patients who were positive for the supine sign had an acute fracture on their MR scan. There were 9 patients who were comfortably able to lay supine who had an acute fracture (sensitivity 81.25%, specificity 93.33%). Either a positive closed fist percussion sign or a positive supine sign is a reliable indicator of the presence of an acute VCF. By incorporating these signs into our routine clinical assessment we are better able to predict which patients have an acute fracture, and therefore decide which patients need a MR scan.
A weighted scoring system is proposed to quantify the risk of sustaining a pathological fracture through a metastatic lesion in a vertebral body. This system analyzes and combines four magnetic resonance (MR) risk factors into a single score.
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