Introduction: The clinical effectiveness of spinal bracing for the conservative treatment of adolescent idiopathic scoliosis is still not fully understood. Cohort studies on clinical effectiveness fail to adequately measure and control for confounding variables including spine flexibility, curve type, magnitude and maturity, distribution of corrective forces and compliance. This paper presents intermediate findings from a longitudinal study to objectively measure brace wear patterns and compliance in users of custom fitted TLSOs in the UK. Braces are fitted with data logging devices to measure temperature and humidity at the skin/brace interface. Previously reported measures of compliance have been in adolescents wearing Boston Braces using questionnaires, strap tension, interface pressure and skin temperature. They have shown compliance reported by the user can significantly over estimate actual compliance.

Methods and results: 20 patients are being studied over 18 months. TLSOs are fitted with data logging devices to measure temperature and humidity at the skin/brace interface. They are discrete sensors inserted into a pocket formed on the posterior of the brace. Measurements are recorded at 16 minute intervals and data downloaded every three to four months. Results clearly demonstrate compliance and daily wear routines. Temperature and humidity at the skin/brace interface during periods of wear are 35°C and > 80%RH respectively. Compliance ranges from 60–98%. Users who stick rigidly to their regime only remove their brace in the evening. Where poorer compliance is evident, the brace is worn sporadically during the day and evening, and worn full time at night.

Conclusion: Measurement of temperature and humidity at the skin/brace interface clearly demonstrates compliance and daily wear routines. Compliance varies from 60–98%. Where poor compliance is an issue it is intended to re-interview these individuals and obtain more detailed information about the reasons why they failed to use the brace.

Aim: To test the null hypothesis that older instrumentations with their complications do not produce a clinical improvement.

Introduction: Surgical treatment of adult scoliosis is difficult with a high incidence of complications. The presenting complaints and expectations from the surgery are different to those in adolescent scoliosis.

Methods and results: Inclusion: All cases of adult idiopathic scoliosis presenting at or after the age of 20 and requiring surgical treatment. Exclusions: Revisions. Average age of follow-up is 6 years (range 2 to 14 years) with 107 patients. For analysis three groups were decided on the basis of the age. A number of different instrumentation systems were used with time. Treatment varied according to senior author’s planning for the individual patient, ranging from posterior instrumentation, anterior release and posterior instrumentation, and combined anterior and posterior instrumentation.

Group I: Age 20–30 years, consisted of 64 patients. Average pre-operative primary curve was 56° with post-operative correction 50%. Deformity was the most common presenting complaint. Seventy-one per cent felt an overall improvement, the rest noticed no benefit.Twenty-two per cent would prefer not to have the surgery. Complications included four pseudoarthrosis, nine required further surgery, and one late infection.

Group II: Age 31–40 years, 20 patients with an average primary curve of 63°, and a correction of 56%. Fifteen per cent had significant pain at presentation. Seventy per cent felt an overall benefit although all noticed a cosmetic improvement. Complications: two pseudarthrosis, three subsequent surgical procedures.

Group III: Age > 41 years, 23 patients, an average primary curve of 72° with a correction of 39%. Eleven out of 23 had significant pain on presentation. Complications: four pseudoarthrosis, metal pull out in one. Further surgery was performed in nine. All felt some benefit from the treatment and despite the high proportion of complications, would have the surgery again.

Conclusions: There is a clinical benefit from surgical treatment of adult idiopathic scoliosis. There is a higher number of complications in the older age group.

Twenty-eight patients undergoing correction of thoraco-lumbar deformity were randomised to either the USS or Colorado 2 spinal instrumentation. Scoliosis was the deformity in 24 cases. Only once the surgical plan was decided upon was the instrumentation randomised, thus not influencing the use of anterior release or not.

Of the scoliotics, seven underwent anterior releases. The average duration was 107 minutes, blood loss 325 ml and number of levels 4.6 discs.

The USS group had 11 scoliosis cases. Nine were idiopathic, one neurofibromatosis and one neuromuscular. The average age at surgery was 18.7 years. The average number of levels fused was 11.4±1.6 (9–14). The average duration of surgery was 237±43.9 (180–330) minutes. The average blood loss was 2460±2204 (500–7500) ml. If the extreme blood loss of 7500 ml was excluded, then the average was 1900±1392 (500–4500). Costoplasties were performed in five cases. Only one case braced.

The Colorado 2 group had 13 scoliosis cases. Ten were idiopathic and three neuormuscular. The average age at surgery was 21.9 years. The average number of levels fused was 11±1.52 (9–14). The average duration of surgery was 198.3±34.9 (150–255) minutes. The average blood loss was 1766.7±863 (850–3800). Costoplasties were performed in five cases. Only one case braced.

Results: There was similar correction between the groups with Colorado 2 having an average of 52±16 (17–67)% and USS 62±17 (38–93)%. As regards instrumentation related failure, one USS hook cut out intra-operatively and needed to be replaced a level lower. In the Colorado group, there was also a laminar fracture. There were two screw cut outs, a hook pull out and two misplaced hooks in the Colorado group.

Conclusions: Both systems provided a similar amount of correction. There were more fixation point problems with the Colorado 2 group than the USS group. Some of these problems were related to insertion errors, but may have been due to migration during the correction process. This may indicate a benefit of the USS hook-screw fixation system.

Aiming to evaluate the efficacy and safety of instrumentation using only segmental pedicle screw fixation, we undertook a prospective study of 17 patients with idiopathic scoliosis who underwent corrective surgery in 1998 and 1999.

A total of 170 pedicle screws was inserted, 119 in the thoracic spine and 51 in the lumbar, extending from T2 to L5. The Cobb angle was measured on an erect anteroposterior radiograph postoperatively and at 6 and 12-month follow-up. Pedicle screw placement was assessed on the radiographs, and where there was concern about screw position, CT scan was performed.

Of the 170 pedicle screws, three were malpositioned lateral to the pedicle and one medial to the pedicle. One pedicle fractured during screw insertion, and three screws partially pulled out on the convex side of the curve at T3 to T5. At six months the mean Cobb angle correction was 53.6%. There were no neurological complications. Two cases required subsequent trimming of rods.

We believe fixation using only segmental pedicle screws is a safe method of correcting idiopathic scholastic deformities, but retain some reservations about the pull-out strength of the uppermost screws in the thoracic spine.