Objective: To assess the temporal geometric sagittal profile changes on serial radiographs of fractures of the thoracic and thoraco-lumbar spine.

Materials and methods: We have included 103 patients with thoracic or lumbar fractures were treated at our unit between June 2003 and May 2006. The patients were suitable for non-operative treatment. The mean age of the cohort was 46.9±2.4 (16–90). The sex distribution was equal. 94 patients had a single level lesion. 19 fractures were in the thoracic spine; 64 in the thoraco-lumbar (T11-L1) and 29 between L2 and L5. The radiographs were scored using the AO classification by 2 senior orthopaedic trainees. The radiographs were analysed at the Spine Research Laboratory. The results were computed using Stat, a statistical software.

Results: The changes were assessed over a mean period of 5.6 mo (range 1–49 mo; 95% CI 4.1–7.1 mo). Weighted kappa score of 0.58 was computed for the primary fracture type and 0.22 for the fracture sub-types. The inter-observer rater agreement was similar to that reported in literature. 7 patients showed a significant collapse. We report the association between the fracture types and the extent of collapse. We have also assessed the association between the medium to long term symptoms, the fracture types and the extent of collapse at the fracture sites and the adjacent disc.

Conclusion: Some fracture sub-types are more likely to collapse and cause long term symptoms. Identifying these fractures at the outset would help clarify surgical indications.

Objective: To do assess changes in patients’ symptoms and the operative plan.

Materials and methods: 147 patients on a spinal surgery waiting list were assessed at a mean wait of 15.8 ± 1.3 months. 89 (61%) were male and 58 (39%) were female at a mean age of 49.7 yrs (16–78). 123 patients had a degenerative condition (20 cervical; 03 lumbar); 20 patients were seen for scoliosis; 2 with a post-traumatic kyphosis and 1 each with ankylosing spondylitis and a psudarthrosis.

Outcomes assessed: Changes in patients symptoms; changes from the initial operative plan when listed; requirement for re-imaging due to the wait.

Results: 31 patients reported improved symptoms at the re-assessment, while 96 were worse off and 20 were unchanged. 137 had axial pain when listed which changed to 116 at review (p=0.0018). 130 had radicular pain when listed which improved to 80 on re-assessment (p< 0.0001). However 19 reported an increase in the axial and 17 in the radicular symptoms. 71 patients (48.3%) required to be re-imaged at the re-assessment due to changes in the clinical picture. 42 patients received the procedure as originally listed. 30 patients were taken off the list, 24 received a different operation, and 38 had an interim or a definitive needling procedure while 13 await a re-assessment.

Conclusions: On the basis of the observations on our cohort, 1 in 5 operations were cancelled; 65% had an increased severity of the symptoms and just 1 in 3 patients were operated as planned while 48% required re-imaging. A long wait inevitably leads to changed symptoms and a review of these patients is mandatory. The review and the re-imaging adds to the burden on the already over-loaded system.

Introduction: Sacroiliac joint pathology can contribute to lowback pain and sciatica. Its frequency and significance is controversial.

Aims: The purpose of this study is to evaluate the incidence and clinical significance of positive SI joint pathology on MRI scans.

Methodology: 353 MRI reports and scans carried out over a one year period for backpain and sciatica were reviewed. Demographic data and clinical notes of patients who had positive SI joint pathology on MRI scans were analysed. Correlation between clinical suspicion of SI joint pathology and MRI findings was studied.

Results: 12 scans showed pathology in the SI joint, an overall incidence of 3.3%.8(66%) were males and 4(33%) females. Only 4(33%) of these patients had Plain Film abnormality. Average age of 41.2 years (33–54). One patient was known case of Ankylosing Spondylitis. Other positive pathology included oedema, sclerois and bridging osteophytes. Clinicians requested inclusion of SI joint in 43 patients. 8 of these were positive, an incidence of 18.6%. In 130 patients, the SI joints were imaged as routine. This yielded positive pathology in 4 patients (3%).

Conclusion: Our study concludes that 18.6% of patients who are suspected to have SI joint involvement clinically have positive pathology on MRI scans.

Routine inclusion of imaging of the SI joint as part of lumbosacral spine MRI for back pain and sciatica shows only 3% positive results.

SI joint should be imaged only if clinically suspected.

Aim: To assess if commonly used scoliosis instrumentation activates metal detectors at airport security gates.

Methods: 20 patientswho had travelled by air following scoliosis surgery were included. The type of instrumentation, number of journeys, body mass index and whether the alarm was triggered off by the airport security detector was recorded. We asked the patients opinion regarding provision of documentary evidence of surgery.

Results: 10 patients had posterior instrumentation, 5 patients -Paediatric ISOLA,4 patients had anterior instrumentation and one patient, anterior and posterior instrumentation. 12 patients (60%) had travelled more than four times by air following surgery corresponding to 48 passes through an airport archway detector.5 patients out of 20 had set off the alarm while passing through the metal detector everytime of which 4 had posterior instrumentation and 1 anterior instrumentation. None of the patients with ISOLA instrumentation set of the alarm. Two patients had set off the alarm every time they passed through the metal detector and both of them had posterior instrumentation. 14 patients(70%) suggested that we should provide documentary evidence of surgery to avoid delays in the airport security check. 25 % of patients set of the metal detector alarm following scoliosis instrumentation.

Conclusion: Patients with posterior instrumentation are more likely to set off the alarm compared to patients with ISOLA instrumentation. It is important to be aware that scoliosis instrumentation can activate airport archway detectors in our present security climate and to provide documentation to patients in order to avoid embarassment and delays.

Introduction: Scoliosis Nursing service was introduced at the Cardiff Spinal Unit in 2003 as part of a multi-disciplinary team to improve quality of care for the patients and their families.

Background: This nurse is a point of contact at pre-admission and discharge. She co-ordinates the peri operative care and liases with other team-members including physiotherapists, occupational therapists and dieticians. Information regarding type of surgery, pain management, wounds/dressings, investigations is offered.

Aims and Objectives: To assess patients’ and families perception and satisfaction with the various aspects of care provided by the Scoliosis Nurse.

Methods and Materials: From 2005 to 2006, 30 consecutive patients and families who had seen the Scoliosis Nurse filled a questionnaire. 25 questionnaires were completed. Response was collated by an independent observer.

Results: All (100%) respondents felt that the presence of a nurse in clinic was beneficial. (100%) reported that they had received adequate information and literature. 66% of the patients felt a pre admission ward visit would be beneficial. 63% felt that further information about discharge and aftercare would be helpful.

Conclusion: Thus the Scoliosis Nurse was perceived to be beneficial by the patients and the family. Based on the abovefeedback the patient Information booklet has been updated.

Paravertebral anaesthesia is a particularly effective, safe and reliable option in scoliosis patients undergoing anterior release in whom percutaneous epidural placement may be difficult to perform. A recent systematic review and meta-analysis of randomized trials has demonstrated that whilst paravertebral block and thoracic epidural insertion provide comparable pain relief after thoracic surgery, paravertebral block placement is associated with a better side effect profile, including a reduction in pulmonary complications, hypotension, nausea and vomiting and urinary retention. We describe a case of a 16 year old female patient who underwent staged correction of her thoracolumbar scoliosis. A paravertebral catheter was inserted under direct vision for continuous infusion post operative analgesia following the anterior release. 48 hours after surgery a swelling was noted in the groin, which was confirmed with ultrasonography as a fluid collection. The swelling resolved upon removing the paravertebral catheter. This suggests that it was caused by the local anaesthetic fluid tracking along the psoas muscle. Retroperitoneal infections, venous thrombosis, femoral hernia, femoral artery aneurysm and inguinal lymphadenopathy are other differentials. Ultrasonography was a fast and sensitive investigation to rule out these differentials and determined that fluid communicating with the abdominal cavity was the cause for this swelling. The infused local anaesthetic had tracked down into the femoral triangle and the swelling resolved upon cessation of the infusion.

Background: Thoraco-lumbar fractures without a neurological deficit are usually suitable for non-operative treatment. The main area of clinical interest is the deformity at the injured levels. The deformity may be evident at the time of presentation, though could be expected to progress in time.

Objective: Accurate assessment of the temporal behaviour in the geometry of the injured segments in non-operatively treated thoracolumbar fractures with normal neurology.

Materials: 102 patients with thoracolumbar fractures without a neurological deficit were treated non-operatively at our unit between June 2003 and May 2006. The mean age of our patient cohort was 46.9 yrs (16–90 yrs). Strict criteria were followed to determine suitability for non-operative treatment. Supine radiographs were performed at the initial assessment. Erect radiographs were performed when trunk control was achieved and at follow-up assessments thereafter.

Methods: Quality Motion Analysis (QMA) software (Medical Metrics Inc, Houston, Tx) was used to measure rotational and translation changes between the end plates using a validated protocol. The radiographs were standardised for magnification and superimposed from different time points. Transformation matrices were used to track the changes. The AO classification was used to classify the fractures by 2 independent observers.

Results: A median of 4 radiographs were analysed for each patient (range 2–9), at a mean follow-up of 5.6 mo (95% CI 4.1–7.1 mo). 92% of the cohort had sustained a 1 level injury. 76% of the injuries were between T12 and L2; 19% were in the thoracic spine. An inter-observer rating of 0.58 was obtained for the classification of the primary fracture type. The mean rotational change was −1.4855° ± 0.248° (95% CI: −0.994° to–1.976°). The mean anterior vertebral body height collapse was −4.3444° ± 0.6938 (95% CI: −2.695 to −5.724). The mean posterior vertebral height collapse was −0.7987 ± 0.259 (95% CI: −0.284 to −1.313).

Conclusions: We report the use of QMA software to track changes in the vertebral body geometry accurately. This has implications on the clinical aspects of management of thoracolumbar fractures based to progression of deformity that could be explored in future studies.

Background data: Previous studies have questioned the quality of information available on the internet. Internet research has proven to more prevalent among scoliosis patients as compared to other orthopaedic conditions.

Aim: Scoliosis websites identified by commonly used search engines were assessed for quality and medical accuracy.

Methods: The word scoliosis was entered into top six search engines and Websites ranked according to frequency. Five websites from the worldwide web and five from the UK only search were evaluated by medical professionals – 4 spinal consultants, 2 registrars, 3 nurses and 1 physiotherapist. 10 patients/carers who had scoliosis surgery also assessed these sites. A scale of 1 to 5 was used for ease of understanding, reliability, clinical correlation, adequacy and links and average score calculated.

Results: None of the top five UK websites figured in the top 5 WWW searchs. Scoliosis research society (SRS) and American Academy of Orthopaedic Surgeons (AAOS) website scored the highest by clinicians and patients in the www list. From the UK list, SAUK website scored the highest with both groups followed by Great Ormond Street Hospital (GOSH) website. We compared the assessment of websites by a healthcare professionals and by patients who had undergone treatment and showed no statistical difference in the scoring.

Conclusion: As treating clinicians it is necessary to educate patients by guiding them to reliable internet sites like SAUK and SRS.

Objective: Prolonged waiting time after being referred for a specialist opinion has plagued the NHS despite pressures to deliver optimum healthcare. We have assessed changes in clinical situation in patients referred to a spinal service while awaiting the first assessment.

Materials & Results: 89 patients were referred to our unit between Jan 2001 and December 2004. The gender distribution in this cohort was equal and the mean age was 50.7 yrs. The mean delay for being seen in the clinic was 28.4 mo (16–58 mo). Significant changes in the symptom pattern were noted in 46 patients, of which 8 patients reported radicular symptoms on a different side. In addition, 7 patients experienced an increased severity in the existing symptoms. 43 patients had been referred to us with an MRI. However due to the delay, 20 of these patients required re-scanning. Following the clinical assessment 25 patients were referred for Physiotherapy, 4 patients required a further clinical review and 44 patients were referred for further imaging.

Conclusion: The problem of excessive out-patient waiting time results in changes in symptom patterns and an increase in the severity of existing symptoms. The changes frequently results in an increased requirement of re-imaging.

Background data: The Paediatric Isola system uses the philosophy of torsion-countertorsion force as a means of scoliosis correction. It aims to maintain this correction till such time that definitive fusion can be carried out.

Aim: This is a retrospective case series of our experience with the Paediatric Isola system and we evaluated the results of this system in the treatment of Scoliosis of various etiologies.

Methods: Twenty –one children,5 with neuromuscular,1 with Ehler-Danlos,5 with idiopathic,3 syndromic and 7 congenital treated with the Isola Instrumentation were studied.

Average age was 6.5 years(2–12). Average follow-up was 24 months (6m-36m).

Results: The average Cobb angle was 52° before surgery, 33.7° after surgery (64 % correction) and 32.5° (62.5% correction) at latest follow-up. The mean apical vertebral translation was 86% and 84% at post-op and latest follow-up. Stabilisation was most commonly perfomed from T2 to L4/L5. Three patients had implant complications, two had deep seated wound infections which necesssiated removal of implants in one case. Five of these patients have gone on to definitive fusions. Curve correction was best for primary thoracolumbar curves and lumbar curves. 2 patients with thoracic curves did not maintain correction.

Conclusion: The Paediatric Isola system is a safe and effective instrumentation in early management of a difficult and challenging sub group of scoliosis patients.

Introduction: Restoration of vertebral height for burst fractures can be achieved either anteriorly, posteriorly or combined.

Aim: To biomechanically assess and compare stiffness of 1) posterior pedicle screws with Synex, 2) Synex+ Double screw+rod Ventrofix 3) Synex+ Double screw+ Single rod and 4) Synex+ Single screw+ Single rod in reconstructing an unstable burst fracture following anterior corpectomy.

Method: Fresh frozen calf lumbar spines (L3–L5) were dissected and L4 corpectomy performed. L3 and L5 were mounted on a plate and fixed. Loads were applied as a dead weight of 2Nm. The range of movement was measured using the Qualisys motion analysis system using external marker clusters attached to L3 and L5. Bony landmarks were identified with marker clusters as baseline. The movement was measured between the 2 marker clusters.

Five specimens were implanted for each group 1) with pedicle screw (into L3 and L5) and tested with/without Synex (expandable) cage anteriorly, 2) implanted with a Synex cage and Double screw+rod Ventrofix system, 3) Synex cage and Double screw+ Single rod Ventrofix construct and 4) Synex cage and Single screw+ Single rod Ventrofix system.

Results: Reconstruction of the anterior column with the combination of Synex and double rod Ventrofix produces a stiffer construct than the pedicle screw system in all planes of movement (p= 0.001 in rotation).

The double screw/ single rod system is less effective than the Ventrofix System but is comparable to the pedicle screw construct.

The single screw/ single rod construct leads to unacceptable movement about the axis of the inferior screw particularly in extension with a ROM much greater than the intact spine (p< 0.001)

Conclusion: Thus biomechanically we recommend Synex and double rod Ventrofix construct to reconstruct the anterior vertebral column following corpectomy for unstable burst fractures.

Aim: To determine the incidence of adjacent level osteophytes in patients who have had anterior cervical fusion using an anterior cervical plate as compared to those who are fused without an anterior cervical plate.

Design: We retrospectively reviewed the lateral radiograms of sixty two patients who have had an anterior cervical fusion with a minimum follow up of twelve months.

Materials and methods: We looked for the development of adjacent level osteophytes in these patients at their final follow up, which was generally at the time radiological fusion. There were 27 patients in the first group who had an anterior cervical plate used to fix the vertebrae in addition to the Cervios cage, while the 35 patients in the second group in whom only a Rabea cage was used for the fusion. The mean follow-up was 20.6 months (range 12–48).

Results: 64.3% of the patients who had an anterior cervical plate developed adjacent level osteophytes while none of the patients who have had the fusion without the cage developed the osteophytes.

Conclusion: We found the patients who had an anterior cervical interbody fusion using a plate had a significant risk of developing adjacent level osteophytes while this is not seen in patients who do not have the plate for the fixation.

Objective: To investigate the clinical outcomes, and the requirement of surgery following selective nerve root block performed for cervical radicular pain in patients with MRI proven disc pathology.

Methods: Thirty consecutive patients with cervical radiculopathy and correlating MRI pathology were studied. Mean age of patient was 46yrs (range 28–64yrs). Twenty nine of the thirty patients also complained of associated neck pain. All underwent fluoroscopically guided, selective cervical nerve root block with steroid (20mg Depomedrone) and local anaesthetic (0.5ml Bupivo-caine 0.25%). Radiographic contrast was used to confirm needle position. All procedures were conducted by the same clinician.

Pre and post procedure pain and physical function scores were noted using the standard SF 36 questionnaire, as well as whether subsequent surgery was required. Mean follow up time was seven months (range 2–13 months).

Results: 81% of patients reported an improvement in arm pain, and 66% in neck pain following the procedure. 77% of patients had an improvement in pain score (mean improvement 16 points). 68% of patients had an improvement in physical function score (mean improvement 20 points). At the time of follow up only one patient had undergone surgery for cervical radicular pain.

Conclusion: This study suggests that fluoroscopically guided selective nerve root block is a clinically effective interventional procedure in the management of cervical radicular pain, and may prevent the need for open surgery.

Patients admitted to trauma wards are routinely screened for MRSA pre-operatively. The majority of them have implant surgery before the screening results were available. The aim of our study was to identify the incidence of MRSA wound infection in these patients and their outcome following it.

We randomly reviewed 40 patients who were colonised with MRSA pre-operatively and have had implant surgeries. The case notes, drug charts and the microbiology were reviewed to identify the incidence of MRSA wound infection and its outcome in these patients. The place of residence, site of colonisation and the treatment given were also considered.

70% of the patients were admitted from home and 20% had previous admission within one year. The commonest site colonised is the nose (50%) followed by the perineum in 20%. Multiple sites were colonised in 10% of the patients. Only 50% of them with positive nasal MRSA were given nasal bactroban and chlohexidine wash was given in only 70% of them with MRSA colonisation in other areas. 22.5% (9/40) of the patients developed MRSA infection post operatively and they were treated with vancomycin or teicoplanin. Wound debridement and washout were done in 67.5%. 75% of the MRSA infected wound healed well with no MRSA in the wound site after treatment. 25% of the MRSA infected wounds had persistent MRSA in the wound.

As per our study the incidence of MRSA wound infection in patients colonised pre-operatively is about 22.5%. Most cases seem to heal well without much complication with appropriate antibiotics and wound care.

Background: More patients are turning to the Internet for health-related information. Studies indicate that this information is being used to make decisions about their management. The aim of this study was to assess the information available specific to scoliosis on the Web using four common search engines.

Methods: Four search engines (Google, Yahoo, Hotmail and Ask Jeeves) were used in scanning the Web for the following key word- “Scoliosis”. Both U.K. only and World Wide sites were accessed. Four Spinal Surgery Consultants independently graded each site for layout, content, relevance to patients as opposed to medical professionals, ease of use and links to other sites. Each point was marked on a scale of 0–2 and a total of 10 points available. Web sites were assessed via U.K. search engines and forty via World Wide search engines. Good was awarded to a site with a score of 7–10; an average awarded for a score of 4–7 and poor was given to a site with a score of 0–4.

Results: For the U.K. search engines, twenty sites were evaluated and five common sites identified (spineuniverse.com, S.A.U.K.org, orthoteers.co.uk, B.O.A.ac. uk and scoilosis.info). From these sites only two were given a rating of good. For the World Wide Web search engines eighteen sites evaluated and seven common sites identified (SRS, spineuniverse.com, scoliosis.org, orthinfo.aaos.org, iscoliosis.com, scoliosisrx.com and scoliosis-world.com). From these sites four were given a rating of good. It was evident that the Scoliosis Association of United Kingdom did not appear in three of the search engines but only in Hotmail.

Conclusion: These results suggest that there are good sites available for patients to access information with regards to their condition and treatment options but there are also very poor sites available where incorrect information is available. Commonly, unfamiliar users of the Web will not search U.K. sites specifically and could easily miss the S.A.U.K. site, which is an excellent site and was one of the two sites via the U.K. search engine awarded a good score. Obviously, there were more good sites via the World Wide Web due to the American healthcare system. We recommend that leaflets should be available to parents and patients with scoliosis with information from the BSS of the condition and available Web sites with good ratings. Also we recommend that these sites be linked to the Royal College of General Practitioners Web site to provide reference on good practice.

Background: Although either anterior or posterior corrective scoliosis surgery has been reported in Jehovah’s Witnesses, we did not find any reports of single stage combined anterior and posterior scoliosis surgery being done in these patients. We report our experience in one such case.

Methods: This is a case report of a 14 year old female Jehovah’s Witness who had cerebral palsy with total body involvement presented with right sided thoracolumbar scoliosis. She was wheel chair bound and was being treated in a spinal brace. She had a partially correctible thoracolumbar curve from T5 to L2 measuring 94°, which reduced to 74° in brace. Her parents were counselled regarding scoliosis surgery. They consented for the surgery and also signed a special consent form for Jehovah’s witnesses specifying that they would prefer their child not to have transfusion of blood or blood products under any circumstances. They were explained that in case of excessive bleeding, further surgery may need to be deferred.

Results: Although her pre-op Haemoglobin was 14.3 g/dl, she was given oral ferrous sulphate because of low serum ferritin level (34 mcg/L). After induction of anaesthesia, intra operative hemodilution was performed using 900 ml of crystalloid. During surgery aprotinin infusion was used with controlled hypotension and cell salvage. Anterior release was performed followed by posterior instrumentation. The operation lasted for 8 hours. Central venous pressure and arterial oxygen saturation remained stable throughout the operation. She recovered well following surgery, with post-operative haemoglobin of 9.8 g/dl and was discharged on the7th post-operative day. Oral iron supplementation has been continued after surgery.

Conclusion: Due to religious reasons, Jehovah’s Witnesses do not accept transfusion of blood and blood products, which makes major surgery like scoliosis correction difficult as it involves a significant amount of blood loss. Such patients benefit from pre-operative iron supplementation, pre-operative haemodilution, intraoperative hemodilution, cell salvage, use of Factor 7, aprotinin and erythropoietin. These modalities have made it possible to perform major operations like scoliosis surgery in this group of patients.

Introduction Local steroid injection is commonly performed as a treatment for facet joint arthritis in the lumbosacral spine. The injection is performed under image guidance for which some surgeons utilise antero-posterior (A-P) imaging only while others prefer oblique imaging.

Purpose The aim of this study is to find out the difference in the functional outcome in patients who received the facet joint steroid injection by A-P imaging and those who had the injection by oblique imaging.

Material and Methods A prospective randomised controlled trial was performed by randomly allocating the 20 patients who were diagnosed to have facet joint arthritis clinically and by magnetic reasonance image scans, and who were then placed in the list for facet joint injections. Ten patients in Group I received the facet joint injections with A-P imaging while 10 patients in Group II received the facet joint injections with oblique imaging using image intensifier. All the patients received 40mg of methylprednisolone acetate with 1mL of 1% lignocaine and 1mL of 0.5% bupivacaine to each joint. The duration of the entire procedure was noted. Short Form-36 (SF-36) questionnaire was used before the procedure and at six weeks after the procedure to assess the functional outcome.

Results All the patients were followed up for a period of six weeks. The mean age was 51.3 yrs in Group I and 48.3 yrs in Group II. The male to female ratio was 3:7 in Group I and 2:5 in Group II. One patient in Group I had the facet injections at only one level while it was in two patients in Group II (L4/5 or L5/S1). Further one patient in Group I and one in Group two had unilateral facet joint injections at two levels. All the other patients had bilateral facet joint injections at two levels (L4/5 and L5/S1). One patient was excluded from the study as the A-P image obtained was very poor and that an oblique image had to be performed to visualise the facet joint because of obesity. The mean duration of the procedure was 18.33 min (10–25 min) in Group I and 22 min (10–35 min) in Group II (p=0.14, 95%CI −8.5 to +1.4). The patient function score improved from a mean of 20.0% to 32.5% after the injection in Group I, and from 30.0% to 41.0% in Group II. The pain score improved from a mean of 33.3% to 47.2% in Group I, and from 35.6% to 44.4% in Group II. The difference in physical function score (p=0.85, 95% C.I. −15.29 to +18.29), and pain score(p=0.71, 95% C.I. −24.21 to +34.22) between the two groups were not statistically significant.

Conclusions There is no difference in the functional outcome of patients treated by facet joint injections using A-P or oblique imaging. There is no significant difference in the duration of the procedure as well between the two techniques. However, with experience we found that it may be difficult to visualise the facet joint clearly by A-P imaging alone in obese individuals.

Background: Campbell et al from Texas have pioneered the use of Vertical Expandable Prosthetic Titanium Rib (VEPTR) in congenital scoliosis. Our centre is the first in the UK to use it and we report our experience of 5 cases done in the past 2 years. VEPTR works on the principle of expansion thoracoplasty and thoracic spinal growth of upto 0.8 cms/year has been reported by the developers of this device.

Methods: This case series includes one child who had the index surgery in America and is undergoing sequential expansion in Cardiff. All surgeries were done using a standard technique with monitoring of somatosensory evoked potentials. After appropriate soft tissue and bony releases, VEPTR was inserted and expanded by 0.5 cms to maintain tissue tension. Subsequent expansions were done as day case surgeries at 4–6 month intervals through a small incision over the VEPTR. We assessed clinical and radiographic assessment, which included – hemithorax height ratio, Cobb angle, interpedicular line ratio, space available for the lung.

Results: There were 3 males and 2 females with mean age of 6.3 years (range 0.9 to 9 years) at the time of index operation. Average follow up is 2 years (0.4 to 5 years). Average hospital stay for the index surgery was 5 days (4–7 days). All patients had mean of 3 expansions (range: 0–6). Mean improvement in the Cobb angle was seen from 48° to 36° at last followup. Space available for lung improved from a mean of 72 % to 86 %. Mean improvement in hemithorax height ratio was from 72.5% to 86%. One child had mild pain due to prominent metalwork; 2 children had transient brachial plexus neurapraxia, one of whom had progression of a secondary cervical curve and is awaiting further surgery for the same.

Conclusion: Our early results show good improvement of clinical and radiographic parameters. Transient nerve palsies have been well reported on the concave side and occur due to traction on the nerves as a result of increased height of the thoracic cage. This occurred in one initial case and has not been seen later. These results are encouraging but do indicate a learning curve.

Background: There has been an exponential rise in Internet use over recent years with over 11 million homes in the United Kingdom currently having access to the Internet. Previous studies have shown that up to 50% of orthopaedic outpatients have researched their condition on the Internet and that this percentage is dependent upon the condition from which they are suffering. The aim of our study was therefore to assess the prevalence of Internet usage among three groups of orthopaedic outpatients and to further determine how the patients felt their Internet research compared to the information received at consultation.

Methods: Data was collected from 150 patients / parents attending three outpatient clinics; 50 consecutive patients attending scoliosis clinic; 50 patients attending paediatric orthopaedic clinic; 50 patients attending back pain clinic.

Results: 58% of scoliosis, 22% of general paediatric and 30% of back pain patients had researched their condition on the Internet. 83% of scoliosis, 64% of paediatric and 80% of back pain patients found this information useful. Nearly all patients, however, would trust their doctor more than the Internet.

Conclusion: We believe therefore that clinicians need to keep up to date with information available on the Inter-net and provide recommended websites to patients wishing to consolidate their knowledge of their condition.

Background: Long waiting lists in the NHS are a cause for public concern especially with regards to progressive conditions like scoliosis. We reviewed records to 61 patients to ascertain whether waiting time had any detrimental influence on their surgical management.

Methods: Retrospective review. Assessment of clinical records and radiographs of 61 patients who had scoliosis surgery over past two years was done by two independent investigators. Patient demographics, waiting times between referral and outpatient review and waiting time for surgery were collected.

Results: There were 41 females and 20 males with mean age of 11.8 years (range, 1– 22 years). Thirty-four patients had thoracic curves (28- right sided), 21 had thoracolumbar curves (19- right sided) and 6 patients had right sided lumbar curves. Mean Cobb angle at presentation was 58° (range,17°–90°) which increased to 71°(range, 30°–120°) at surgery. Average waiting time to be seen in the clinic was 16 months. Average waiting time for surgery was 10 months. Rapid curve progression was seen in twelve patients (20%), of which 10 required more extensive surgery than originally planned. Their mean Cobb angle at presentation was 48° (range, 45°– 80°), which increased to a mean of 59° at surgery (range, 50°–92°). At presentation their Risser grades were: 5 – grade 0, 3- grade 2, 2- grade 4. These 10 patients had waited averagely 7.8 months to be seen in the clinic and for 11 months to have the surgery.

Conclusion: Significant curve progression occurred in 20 % of patients waiting to have scoliosis surgery. Ten of those required much more extensive surgery than originally planned. Long waiting times therefore have a detrimental effect on the surgical management of scoliosis patients.