Introduction: The management of deformities of the lower extremity in children with spina bifida is challenging. Surgery is fraught with high complication and recurrence rates. The Ilizarov technique has shown to be a successful tool in the management of complex lower limb deformity. There are few published series in the literature dealing specifically with Ilizarov correction of complex lower limb deformities in spina bifida. In this paper we present our experience of the Ilizarov technique for complex deformities in children with spina bifida. Methods: From 1989 to 2006, 33 patients with spina bifida underwent 48 corrections of their lower extremity deformity using the Ilizarov technique at one of three tertiary care centres (Royal Children’s Hospital, Melbourne, Australia, Musgrave Park Hospital, Belfast, Northern Ireland and Birmingham Children’s Hospital, Birmingham, UK). Notes were reviewed retrospectively. Patient demographics, indications for surgery, deformity analysis and the extent of surgery were recorded. Complications of the surgery and outcomes were noted. Results: Group I comprised of 12 fixed knee flexion deformities and one unstable neuropathic joint. Group II comprised 15 external tibial rotational deformities. Group III comprised 20 complex foot deformities. The mean age of the patients was 12.1 years (5.2–20.6 years). Prior to their treatment using the Ilizarov technique patients had undergone a mean of 1.6 previous surgeries (range: 0–5) on the affected limb. The mean duration of treatment in the frame was 9.3 weeks (range: 2–26 weeks). The mean follow-up is 4.0 years (range 0.3–9.0 years). Thirteen problems occurred in the 48 procedures (27.1%). Five obstacles occurred in the 48 procedures (10.4%). Thirteen complications occurred in the 48 procedures (27.1%). Further surgical procedures are either planned, or have been performed, in 8 of the 33 patients (24.2%). Following treatment, all feet were recorded to be plantigrade. All were comfortable in their respective orthoses where appropriate. Conclusion: Through the pitfalls in treating the complex lower limb deformity in spina bifida, the Ilizarov technique offers a refreshing approach. It offers distinct advantages throughout the treatment period. It modifies both the intraoperative and postoperative environment to address the morbidity of the significant complications associated with the traditional approach to the correction of the limb deformity in the child with spina bifida. Significance: This is a large series of complex limb reconstruction cases in spina bifida showing excellent results, an acceptable complication rate and recommendations for further use of this technique

The authors comment on the treatment of patients suffering from spina bifida. The indications to surgical-orthopaedic approach for lower limb correction in patients with spina bifida are outlined. According to the authors’ experience, the therapeutic approach should be aimed at treating deformities of the lower extremities in order to apply orthotic devices, particularly for higher levels of medullary lesion, and to obtain standing and/or gait with support. In the natural history of spina bifida, this purpose has become more and more important, since reduced complications, longer average life, and improved clinical, therapeutic and technological knowledge have radically changed the life expectancy of these patients. The analysis of a series of 71 patients with spina bifida, treated over 20 years, has enabled the authors to evaluate the main sites of deformities. They examined the surgical procedures carried out in relation to the levels of damage and observed the resulting functional autonomy. The foot was the site which offered the most frequent opportunities for treatment at all levels. Knee deformities were treated in a few cases. In particular, difficulties arose when treating L3-L4-L5 neurosegmental levels of the hip, with the result that today bone correction of this joint is performed in association with muscle transposition (external oblique abdominis m. pro medio gluteus m.) in order to ensure a dynamic correction. The authors emphasise the need for a more cautious surgical approach, since lower limb alignment, often achieved using orthopaedic aids and splints, is more important from a functional point of view than the anatomic and radiographic correction of the deformities. From a functional point of view, apparently positive neurosegmental levels for functional recovery are damaged by the lack of early training using splints. Actually, even severe clinical conditions can acquire increased functional autonomy if splints are early introduced to aid walking. Moreover, there are increased indications for spinal surgery in patients suffering from severe paraplegia in order to improve cardio-respiratory function. A correct alignment and an adequate application of orthotic devices reduce the frequency of pelvic obliquity, which favours spine deformities

Purpose of the study: In spina bifida, independently of limb paralysis, spinal deformation can cause significant static disorders (scoliosis, kyphosis, or hyperlordosis) which in turn cause significant disability. These deformations generally develop during growth. We wanted to determine the predictive value of a clinical classification based on the neurological examination at five years for risk of spinal deformation. Material: This retrospective study included 163 patients. Groups were defined on the basis of motor function determined by the neurological examination at five years: group I: L5 or below (all patients in this group had motor deficit leaving at least one L5 segment intact); group II: L3–L4; group III: L1–L2; group IV: T12 and above. Results: Results showed that group I was a factor predictive of an absence of future spinal deformation. Groups III and IV were predictive of presence of a future spinal deformation. Group IV was predictive of future kyphosis. Discussion: It is well known that the higher the neurological lesion in spina bifida, the higher the rate of spinal deformation. No work has however set the limits nor provided predictive rules useful in clinical practice. Our work demonstrated that this classification based on the motor function established by neurological examination at five years can predict which children have a risk of developing a spinal deformation and thus enabling early detection and treatment. Conclusion: This neurological classification can be used as a clinical tool for the prognostic evaluation of spina bifida

Background: The simultaneous occurrence of spina bifida occulta (SBO) and spondylolysis has been noted previously. The occurrence of SBO and spondylolysis are approximately 17% and 5% respectively. Aims: The aim of this study was to determine the incidence of SBO when a symptomatic spondylolysis has been proven. Method: Analysis of four years of lumbar spine CT scans was performed. Patients with spondylolysis or spondylolisthesis caused by a pars defect were identified. These patients’ CT images were then reviewed to establish the patients who also had SBO. Results: In this unit 650 CT scans of lumbar spines were performed in the last five years. Of these scans 100 (15%) were found to have a pars defect. The average age was 34.6. On CT 30 (30%) patients were shown to have SBO. Of the total 23 were under 18 years old and 13 (56%) of these patients had SBO associated with the spondylolysis. In the over 18 year olds 21 (27%) patients had SBO associated with spondylolysis. On review of the 550 other scans the average age was 51.9 years old. The incidence of SBO within this group is 10%. Only 6% of these patients were under 18. Out of these 33 patients 30.3% (10 patients) had SBO. Over 18 the incidence of SBO was only 8.5%. Conclusions: Our results indicate that the occurrence of SBO within the group with a spondylolysis is much higher than in the group where no spondylolysis is present. There is higher incidence of SBO in the younger patients with spondylolysis. 56% of paediatric patients with symptomatic spondylolysis will have SBO. Clinicians should be aware of this fact preoperatively to decide on the technique of repair of the symptomatic lysis

Background. Spondylolysis (SL) of the lower lumbar spine is frequently associated with spina bifida occulta (SBO). There has not been any study that has demonstrated biomechanical or genetic predispositions to explain the coexistence of these two pathologies. Purpose. To test the hypothesis that fatigue failure limits will be exceeded in the case of a bifid arch, but not in the intact case, when the segment is subjected to complex loading corresponding to normal sporting activities. Methods. Finite element models of natural and SBO (L4-S1) including ligaments were loaded axially to 1kN and were combined with axial rotation of 3°. Bilateral stresses, alternating stresses and shear fatigue failure on intact and SBO L5 isthmus were assessed and compared. Results. Under 1kN axial load, the von Mises stresses observed in SBO and in the intact cases were very similar (differences < 5MPa) having a maximum at the ventral end of the isthmus that decreases monotonically to the dorsal end. However, under 1kN axial load and rotation, the maximum von Mises stresses observed in the ipsilateral L5 isthmus in the SBO case (31MPa) was much higher than the intact case (24.2MPa) indicating a lack of load sharing across the vertebral arch in SBO. When assessing the equivalent alternating shear stress amplitude, this was found to be 22.6 MPa for the SBO case and 13.6 MPa for the intact case. From this it is estimated that shear fatigue failure will occur in less than 70,000 cycles, under repetitive axial load & rotation conditions in the SBO case, while for the intact case, fatigue failure will occur only after more than 10 million cycles. Conclusion. SBO predisposes SL by generating increased stresses across the inferior isthmus of the inferior articular process, specifically in combined axial rotation and anteroposterior shear

Introduction. Lumbar spondylolysis is a fatigue fracture of the pars interarticularis and correlates with Spina Bifida Oculta (SBO) in 67%. 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. Aim of investigation. Finite element (FE) analysis of altered load transfer in combined axial rotation and anteroposterior shear in SBO potentially predisposing to fatigue fracture of the pars interarticularis. Methods. FE models of natural and SBO (L5-S1) including ligaments were axially load to 1kN and an axial rotation of 3° applied. Bilateral stresses and strains on intact and SBO lateral inferior lines of the L5 isthmus were assessed and compared. Results. Under 1000N axial load: Maximum von Mises stress observed on left and right lateral inferior lines of L5 isthmus were 0.13 and 0.24 MPa, with maximum equivalent strain values of 1.56 and 2.91 (strain, for natural spine and SBO, respectively. Combined with 3° axial rotation (rotation of spinal processes toward right lateral side): Left lateral L5 isthmus stresses increased to 0.49 and 0.77 MPa for natural spine and SBO, respectively. Right lateral L5 isthmus values increased to 0.67 and 0.95 MPa for natural spine and SBO, respectively. The percentage increase in SBO strains compared to the natural spine on the L5 isthmus were +57.9 and +40.2%. Conclusion. Significant load transfer occurs through the vertebral arch in axial rotation. In SBO this load transfer is lost and mechanical demand on the isthmus is significantly increased. Strain increases across the L5 isthmus in axial rotation by +40.2% to +57.9% compared to normal and may predispose to fatigue fracture

Purpose: The purpose of this study was to evaluate a possible correlation between DDH and lumbosacral spina bifida occulta (LSSBO). Patients and Methods: This multicentric study included the assessment of anteroposterior pelvic radiographs of 415 adolescents and adults without any bilateral clinical and radiological hip joint abnormality and of latest radiographs of 291 adolescent and adult patients who had treated or untreated DDH which had occured unilaterally or bilaterally. Control group included 332 females and 83 males and mean age was 38±17 (12-70) years. DDH group included 246 females and 45 males and mean age was 30±17 (12-80) years. Results: Female/male ratio of both groups was statistically similar (p=0.124). Rate of LSSBO was 12% and 23% in the control and DDH groups, respectively (p< 0.001). S1 and L5 vertebrae were the two most common involved sites in both groups. There wasn’t any significant correlation between the rate of LSSBO and the involved hip side in the DDH group (p=0.336). In females, rate of LSSBO was 9% and 23% in the control and DDH groups, respectively (p< 0.001). In males, rate of LSSBO was 22% and 24% in the control and DDH groups, respectively (p=0.893). Conclusion: In females, DDH is significantly accompanied by LSSBO and LSSBO may be considered as a risk factor for DDH. Further intrauterine studies are needed for better understanding of this fact. It may be better to perfom ultrasonographic hip screening for the newborns who has an evident posterior vertebral arch defect without any intraspinal anomaly which has been seen during fetal ultrasonography

Aims

The aim of this study is to define a core outcome set (COS) to allow consistency in outcome reporting amongst studies investigating the management of orthopaedic treatment in children with spinal dysraphism (SD).

This is an outcome study of patients with spina bifida treated for scoliosis by anterior and posterior spinal surgery at the Starship Children’s Hospital. The clinical notes and radiographs were reviewed of all spina bifida patients with scoliosis undergoing surgery between January 1991 and January 2001. In addition all patients were sent the Spina Bifida Health Related Quality of Life Questionnaire (HRQOL) and the Spina Bifida Spine Questionnaire (SBSQ). There were 19 consecutive patients with an average age at surgery of 13 years 5 months. Four patients had both anterior and posterior instrumentation. 14 patients had staged procedures. There was an overall improvement in scoliosis of 61% and pelvic obliquity of 70% at latest follow-up that averaged 60 months. The major complications included 4 deep infections and 2 pseudarthroses. The patients scored an average of 68.8 on the SBSQ. The average score for 5–12 years old was178 and for 13–30 years old, 163, on the HRQOL questionnaire. There are good radiological results with combined anterior/posterior surgery in this group of spina bifida patients. Quality of Life does not seem to be greatly compromised in the operated spina bifida patient. We recommend early single stage anterior and posterior fusion for these patients before the curve becomes too large and stiff

Introduction This is an outcome study of the patients with spina bifida treated for scoliosis by anterior and posterior spinal surgery by a single surgeon at one institution. Method The clinical notes and radiographs were reviewed of all spina bifida patients with scoliosis undergoing surgery between January 1991 and January 2001. In addition all patients were sent the Spina Bifida Health Related Quality of Life Questionnaire (HRQOL) and the Spina Bifida Spine Questionnaire (SBSQ). Results There were 19 consecutive patients with an average age at surgery of 13 years 5 months (range). The average neurologic level was T10 (range). 14 patients had staged procedures. At latest follow-up which averaged 60 months (range), there was an overall improvement in scoliosis of 61% from a mean of 83 degrees preoperatively to a mean of 34 degrees postoperatively. There was a corresponding 70% improvement in pelvic obliquity from 27 degrees preoperatively to 8 degrees postoperatively. At latest follow-up which averaged 60 months (range). The major complications included 4 deep infections and 2 pseudarthroses. The deep infections occurred in older patients with more severe curves and were always staged procedures. The patients scored an average of 68.8 on the SBSQ (what does this mean?). The average score on the HRQOL questionnaire for patients 5–12 year old was 178 and 163 for 13–20 year olds. Discussion There are good radiological results with combined anterior/posterior surgery in this group of spina bifida patients. The outcome scores show that this group of patients enjoy a good quality of life when compared to control groups of similar children with the same condition. An early single stage anterior and posterior spinal fusion is recommended for these patients before the scoliotic curve becomes too large and stiff

There is conflicting information regarding the recommendations of bracing, physical therapy and cessation of sports for young athletes with symptomatic spondylolysis. The purpose of this study was to identify factors affecting the prognosis and to find the optimal method of non-operative treatment. The patients in our study were athletes who visited our children's hospital for low back pain with lumbar spondylolysis and were treated non-operatively from 1990 to 2002. Clinical and radiological outcomes were reviewed retrospectively. The effects of bracing, physical therapy, cessation of sports, duration of symptoms before the first hospital visit, lateralisation of spondylolysis, age, gender, onset of low back pain after lumbar trauma during sports, bone scan uptake, vertebral level of the lesion, associated scoliosis or spina bifida and radiological bony healing were analysed using univariate and multivariate analysis with logistic regression. The mean age of patients was 13 years (range 7 to 18 years). The mean follow-up was 4.2 years (range 1.2 to 12 years). Of 132 patients, 48 patients had excellent results with no pain during sports, 76 good, 6 fair, and 4 poor. Cessation of sports, early non-operative intervention, and a unilateral spondylolysis appeared to be factors associated with excellent outcomes. However, bracing, physical therapy, age, gender, level of lesion, history of trauma, increased uptake on bone scan, or associated scoliosis or spina bifida were not factors. Bony healing was not related to the clinical outcome. The non-operative treatment of spondylolysis in children can yield excellent clinical outcomes, and the absence of bony healing has no influence on clinical outcome. Factors in this study found to correlate with an excellent outcome include unilateral spondylolysis, acute spondylolysis, and treatment with cessation of sports for 12 weeks

Incidence of Congenital talipes equino varus [CTEV] is 1 to 2 per 1000 birth, Out of all cases 20% cases are Non-idiopathic. The management of non-idiopathic CTEV, however, continues to be challenging due to Rigidity, Poor skin condition, Bony changes, Vascularity and Associated congenital abnormalities. In recent literature, short term results of Ponseti method for correction of non-idiopathic CTEV have been encouraging. As Ponseti method decreases the severity of deformity and hence decreases the need for extensive surgery. The aim of current study is to evaluate the results of Ponseti method in Non-idiopathic CTEV. Total 7 children below the age of one year with Non idiopathic clubfoot presented to us in the duration of 2013 to 2015 who were treated by us. The cases included are Streeters Dysplasia with congenital constriction rings 3, Arthrogryposis multiplex congenita with Developmental dysplasia of hip 2, Arthrogryposis multiple congenita spina Bifida 1, Pierre Robinson Syndrome with Ichthiosis 1. Initially all the patients treated with Ponseti casting technique and scoring was done using modified pirani scoring. At an average we could correct the foot from Pirani 7 to 2.5 with a relapse in 4 patients. 2 patients were treated again by Ponseti's method with success while treatment was discontinued in 2 feet. We recommended Ponseti's technique in Syndromic clubfoot as an non-surgical initial modality with good results given. The final outcome may depend more on the underlying condition than the CTEV

Introduction: Although hip dislocation is of little functional importance concerning walking ability in most spina bifida patients, relocative surgery may be considered to improve sitting balance or gait pattern in some. The risk for re-dislocation may provide further information to be considered in decision making. Material and methods: A retrospective cohort study included all patients with spina bifida of our unit in which dislocated hip joints were surgically relocated between 1983 and 2000. This procedure including femoral and pelvic corrective surgery, open reduction and soft tissue procedures if necessary, was carried out as a routine in all hip dislocations because hip stability was regarded beneficial for function. The patients were grouped according to the presence of hip dislocation or subluxation: A) within the first year of life, B) later. Group A consisted of 8 (3m, 3f), group B of 10 patients (5m, 5f). In group A 11 (5r, 6l), and in group B 13 hips (7r, 6l) were treated. The neurological levels did not differ between the groups. The hip subluxation or dislocation was diagnosed at age 0.3 years (+0.5 / -0.2 years) in group A and 8.7 years (+6.8 / -5.6 years) in group B. The first corrective hip intervention was done at age 4.6 years (+3.4 / -1.9 years) in group A, at age 9.5 years (+6.6 / -6.2 years) in group B. The follow-up time was 6.8 years (+6.2 / -6.5 years) in group A and 5.0 years (+6.7 / -4.8 years) in group B (p = 0.42) (mean values, range). Results: In group A (n=11 hips) only 1 hip remained stable located. Altogether 14 re- dislocations occurred and 10 additional re-locative operations were performed (some hips were operated on several ocasions). Seven hips were dislocated at final control. In group B (n=13 hips) 10 hips remained stable located, and 3 hips re-dislocated. One re-operation was successful, another one failed. Hence 2 hips were dislocated at final control. The difference between group A and B were statistically significant (p = 0.008). Discussion: Hip deformity present already within the first year of life is a predictor for a poor outcome of relocating surgery, whereas such surgery has a good prognosis in deformities developed later in life. This may be even more important as it has been shown that muscle balance is not a problem

Aim. To demonstrate the use of indium-111 white-cell labelled SPECT CT (In111-WC-SPECT-CT) in bone infection. Method. This novel imaging modality is useful in bone infection. We present three cases of complex osteomyelitis to illustrate this. All were imaged with conventional modalities, but conclusive diagnosis could not be achieved. In111-WC-SPECT-CT was used to provide the definitive imaging that allowed successful treatment. Results. Case 1- A 29 y/o Male with spina bifida presented with chronic calcaneal osteomyelitis. Previous treatment included debridement, but recurrent infection ensued. MRI showed widespread changes consistent with infection throughout the calcaneus and a below knee amputation was planned. In111-WC-SPECT-CT (Figure 1) showed a distinct localised nidus of infection. A targeted sequestrectomy was performed and the patient has been infection free for four years. He was spared the amputation. Case-2- A 73 y/o male presented with a radiation induced colo-cutaneous fistula and pelvic chronic osteomyelitis. Surgical treatment included multiple debridements and sequestrectomy. He re-presented pain with pain in his pelvis six months later. MRI was performed and oedema seen in the bone. This was presumed to be infection and further surgery was planned. An In111-WC-SPECT-CT was then performed and confirmed no residual bone infection. The patient was spared surgery. Case-3- A 38 y/o female was involved in an RTA 6 months prior to presentation. She underwent fixation of her tibia with skin grafting for an open fracture. There was clinical suspicion of deep infection. The metalwork made MRI difficult to interpret. An In111-WCC-SPECT-CT confirmed infection around the metal screw and this evidence instigated a prolonged course of antibiotics to suppress the infection. The screw will be removed after the fracture heals. Conclusions. In-111-WC-SPECT-CT is an emerging imaging modality. We present three cases of complex bone and joint infection; where this imaging has altered the course of treatment

Aims

The aim of this study was to gain an agreement on the management of idiopathic congenital talipes equinovarus (CTEV) up to walking age in order to provide a benchmark for practitioners and guide consistent, high-quality care for children with CTEV.

Corynebacterium Jeikeium is a pathogen rarely involved in orthopaedic infections. Till date only 14 cases of osteomyelitis are described in the literature, envolving the tibia, foot and prosthethic (hip and joint) infection. To our knowledge, Corynebacterium Jeikeium as not been reported as an infectious agent of the spine. Our goal is to describe a case of scoliosis surgical site infection by a Corynebacterium Jeikeium specimen. This is a retrospective and descriptive case report based on data from clinical records, patient observation and analysis of complementary exams. We present a 24 year old female with a history of premature birth, West syndrome, spastic cerebral palsy and spina bifida. She was sent to our consult for evaluation of dorsolombar scoliosis. In October of 2014, she was submitted to surgery – posterior spine arthrodesis and instrumentation (D10 to L5) with bilateral pedicle screws and two chromium-cobalt bars. The early post-operative period was without complications. She was discharge at the seventh day of internment and was seen, fifteen days postoperative, at the consultation office, where the dressings were changed, with no signs of surgical site infection. One month post-operative, she recurs to the office because of an apparent seroma at the surgical site wound. There was no reference to fever or other signs of local/systemic infection. A swabbing of the wound was done and the patient was medicated with Ciprofloxacine, 500mg 12/12 hours – the culture came back negative. Seven days later she was seen again, maintaining the seroma with purge of a serous-aspect fluid. Antibiotic therapy was maintained and another swabbing was collected – culture came back negative. Because of suspected surgical site infection, she was re-operated at December of 2014. Surgical wound debridement was performed; three tissue samples and one exudate were sent to the microbiological department. In all samples but one was identified a Corynebacterium Jeikeium. No sensitivity test was performed. Intravenous Vancomicine, 1 gram 12/12 hours was started and maintained during 8 days. Eleven days post-operative she was discharged with oral Vibramicin, 100 milligrams 12/12 hours for two weeks. She is currently being followed at the doctor's office, with no sign of reinfection of the surgical site. This is the first reported case describing an infection of the spine by a Corynebactereium Jeikeium. Isolation of the causative agent of infection and literature-based directed antibiotherapy are important for a successful outcome

Introduction:. Peroneal muscle weakness is a common pathology in foot and ankle surgery. Polio, charcot marie tooth disease and spina bifida are associated with varying degrees of peroneal muscle paralysis. Tibialis Posterior, an antagonist of the peroneal muscles, becomes pathologically dominant, causing foot adduction and contributes to cavus foot posture. Refunctioning the peroneus muscles would enhance stability in toe off and resist the deforming force of tibialis posterior. This study determines the feasibility of a novel tendon transfer between peroneus longus and gastrocnemius, thus enabling gastrocnemius to power a paralysed peroneus tendon. Method:. 12 human disarticulated lower limbs were dissected to determine the safety and practicality of a tendon transfer between peroneus longus and gastrocnemius at the junction of the middle and distal thirds of the fibula. The following measurements were made and anatomical relationships quantified at the proposed site of the tendon transfer: The distance of the sural nerve to the palpable posterior border of the fibula; the angular relationship of the peroneus longus tendon to gastrocnemius and the achilles tendon; the surgical field for the proposed tendon transfer was explored to determine the presence of hazards which would prevent the tendon transfer. Results:. The mean angle between the tendons of peroneus longus and gastrocnemius/achilles tendon was 3°. The sural nerve lies on average 30 mm posterior to the palpable posterior border of the fibula. There were no significant intervening structures to prevent the proposed tendon transfer. Conclusion:. The line of action of peroneus longus and gastrocnemius are as near parallel as to be functionally collinear. The action of gastrocnemius may be harnessed to effectively power a paralysed peroneus longus tendon, without significant loss of force owing to revectoring of forces. The surgical approach to effect such a tendon transfer is both safe and practical

Introduction. Developments in the use of ultrasound during pregnancy for assessment of fetal spine abnormalities indicate a need for accurate information about the antenatal development of the vertebral column. The published work is deficient in this regard, with available data examining only the period of 8–26 weeks. The aims of this study are to establish antenatal spine growth curves with fetal radiographs, to establish growth velocity curves for each anatomical spinal, region and to calculate the multiplier factor during antenatal life. Methods. 75 anteroposterior spine radiographs were retrieved from the fetal pathology unit. Cases with spinal anomalies were excluded from analysis. Individual vertebral regions were measured from radiographs with the method of Bagnall and colleagues,1 with use of DICOM software. Polynomial regression analysis was applied to each measurement with PASW statistics 18 (SPSS, Chicago, IL, USA). Results. 47 cases were included in the analysis. Gestational age ranged from 14–40 weeks. Growth velocity was greatest in the thoracic region and least in the sacral region. The table shows regression equations for each spinal region. Conclusions. Regression equations from this study will have direct clinical application in the antenatal ultrasound assessment of fetal maturity and normality, particularly the third trimester data. Use of the standard error of the estimate as an approximation to normal values will allow antenatal identification of anomalies, particularly in cases of scoliosis, spina bifida, and anencephaly

Introduction. Taylor Spatial Frame (TSF) has been designed to treat complex tibial, foot and ankle deformities using computer software. We have performed various osteotomies in combination with different soft tissue procedures, with the use of TSF. Material and Methods. A retrospective study of 20 consecutive patients operated by, senior author SSM, from 2004 onwards who underwent surgical correction of tibia, ankle, midfoot and hind foot including lateral column lengthening, calcaneal and midfoot osteotomies. Demographic details, diagnosis, procedures (including previous operations), length of follow-up, outcome and complications were recorded. Of the 20 patients, 13 were men and 7 women. The mean age was 39 years (range 18 to 70). 5 patients had TSF for malunion or non-union of ankle fractures, malunion of tibia (5), congenital talipes equino-varus(3), acute fracture of ankle (2), one patient each for spina bifida, Poliomyelitis, Charcot-Marie-Tooth disease, equino-varus due to periventricular leuco-encephalopathy and avascular necrosis of the talus. Bilateral TSF for torsional malalignment of tibia (1). Results. Follow up 6 to 54 months (mean 19.4). Patient based foot and ankle outcome criteria were used. Of the 20 patients, 16 had no pain and satisfactory range of movement and function at the last follow up. Post-operative complications included pin site infection(2) and frame hardware malfunction (2)patients, residual deformity requiring surgical correction at 22 months, (1) delayed union, neuropathic pain in (1), residual equinus deformity requiring Botox injections(1) and osteomyelitis requiring debridement(1). Conclusion. We present this series of complex congenital and acquired conditions of the foot and ankle treated with corrective osteotomies and Taylor Spatial Frame with good results

Background: It remains unclear and controversial whether preoperative magnetic resonance imaging (MRI) in patients with adolescent idiopathic scoliosis (AIS) should be mandatory. Aim: (1) To review our own practice, (2) conduct a national survey of United Kingdom Consultants, and (3) to perform a literature review. Methods: Our own practice was established by identifying patients with AIS and examining whether an MRI scan was performed preoperatively. A survey of Consultants practice in the UK (British Scoliosis Members) was conducted by either an e-mail or telephone conversation. Finally, a literature survey was performed to establish current views. Results: 118 patients with AIS were identified between 2003 and 2007. 78% of these patients underwent pre-operative MRI scans. Neural axis abnormalities were found in 8% of these patients. They included syrinx’s, chiari malformations, tonsillar herniation, cord tethering, central canal dilatation and undiagnosed spina bifida. Only 1 patient required intervention by the neurosurgeons. 92% of respondents to the national survey routinely performed preoperative MRI scans. The literature was not conclusive with regards to mandatory preoperative imaging. Conclusion: Despite the literature showing little evidence, our survey shows a widespread consensus in clinical practice across the UK that routine preoperative MRI should be performed from a risk management viewpoint. It is mandatory in our unit to perform pre-operative MRI scans on all patients with AIS and would recommend that this becomes standard practice in all other units. Ethics Approval: None/Audit. Interest Statement: None