The incidence of degenerative scoliosis in the lumbar spine is not known. In the ageing population deformity may coexist or cause stenosis. MRI gives limited information on this important parameter in the treatment of stenosis. The aim of this study was to highlight the incidence of coronal abnormalities of the lumbar spine dependent on age in a large population of patients.

We reviewed all abdominal radiographs performed in our hospital over ten months. 2276 radiographs were analysed for degenerative lumbar scoliosis and lateral vertebral slips in patients who are ≥ 20 years old. Evidence of osteoarthritis of the spine was also documented. Radiographs were included if the inferior border of T12 to the superior border of S1 was visualised and no previous spinal surgery was evident (metal work).

2233 (98%) radiographs were analysed. 48% of patients were female. The incidence of degenerative lumbar scoliosis, lateral listhesis and osteoarthritis increased with age. Degenerative scoliosis was present in 1.6% of 30–39 year olds increasing every decade to 29.7% of patients 90 years or older. In all age groups curves were more frequent and had greater average Cobb angles in female patients except in the 30–39 year olds - where males equalled females.

Degenerative lumbar scoliosis starts to appear in the third decade of life increasing in frequency every decade thereafter, affecting almost a third of patients in the ninth decade. It is more common in female patients and has a greater magnitude. Deformity may be even greater on standing views and is important to recognise in all patients that are undergoing lumbar spinal decompressive surgery. A failure to do so may lead to inferior results or the need for further surgery.

Introduction: The incidence of degenerative scoliosis in the lumbar spine is not known. In the ageing population deformity may coexist or cause stenosis. MRI gives limited information on this important parameter and is often the only investigation used pre-operatively in the treatment of stenosis. The aim of this study was to highlight the incidence of coronal abnormalities of the lumbar spine dependent on age in a large population of patients requiring abdominal and KUB radiographs at our institution.

Method: We reviewed all abdominal and KUB radiographs performed in our hospital in the first ten months from the introduction of our digital PACS system. 2276 radiographs were analysed for the incidence of degenerative lumbar scoliosis and lateral vertebral slips in patients who are ≥ 20 years old, in ten-year age ranges. Evidence of osteoarthritis of the spine was also documented. Radiographs were included if the inferior border of T12 to the superior border of S1 was visualised and no previous spinal surgery was evident (metal work/laminectomy).

Results: 2233 (98%) radiographs were analysed. 48% of patients were female. The youngest patient was 20 and the oldest 101 years. The incidence of degenerative lumbar scoliosis, lateral listhesis and osteoarthritis increased with age.

In all age groups curves were more frequent and had greater average Cobb angles in female patients except in the 30–39 year olds–where the males equalled females in frequency and had the greatest Cobb angles.

Conclusions: Degenerative lumbar scoliosis starts to appear in the third decade of life and increases in frequency every decade thereafter, affecting almost a third of patients in the ninth decade. It is more common in female patients and has a greater magnitude. Deformity may be even greater on standing views and is important to recognise in all patients that are undergoing lumbar spinal decompressive surgery. A failure to do so may lead to inferior results or the need for further surgery.

Purpose: To evaluate the indications, outcome, risk factors and complications of transpedicular osteotomy (TPO) in revision scoliosis surgery

Methods: We evaluated patients undergoing TPO for revision scoliosis surgery at our institution between 1989 and 2004 with a minimum follow up of 18 months. Demographic data, anaesthetic risk factors, peri-operative data and complications were recorded. Radiographs pre-operatively, post-operatively and at last follow up recorded sagittal balance, coronal balance, lumbar lordosis and pelvic parameters. Functional outcome was measured using the Whitecloud score.

Results: 21 patients (24 TPO’s) mean age 48.7 years with mean follow up 4.4 years fulfilled criteria for study. All cases had fixed sagittal imbalance pre-operatively. Mean operative time was 4.6 hours and mean transfusion requirement was 2.3. units. A significant improvement (p< 0.03) in sagittal imbalance was gained (although in 3 cases of pseudarthroses this was partially lost) and the post-operative lumbar lordosis correlated closely significantly pelvic incidence (p< 0.03). Functional outcome was good/excellent in 67% cases.

We report 28 complications. 22 early included 4 dural tears, cardiac decompensation with reduction, 5 neurological deficits including a parpaplegia secondary to haematoma which was evacuated and the patient made a good recovery at 6 months, 2 UTIs, IVI infection, superficial wound infection and extension of metalwork due to early proximal decompensation. Late complications included infection (8 years), removal of prominent metalwork, radiculopathy due to screw (6 months) and 3 pseudarthroses. There was no statistically significant correlation of complication with weight, ASA grade or smoking.

Conclusion: TPO in revision scoliosis is an effective method of correcting both coronal and sagittal imbalance but is not without complication, although good functional outcome is achieved in most patients. It is important to consider pelvic parameters pre-operatively to plan the level and magnitude of TPO required.

The purpose of this study was to identify aetiological that may determine prognosis in ulnar nerve lesions and to evaluate the role of non-operative treatment. 148 consecutive patients (100 male) with 170 electrophysiologically proven (by nerve conduction and electromyography) ulnar nerve lesions were identified from the departmental records. Patient details, symptoms, known aetiology and treatment profile were recorded. Each patient was then contacted by telephone and/or questionnaire 1–6 (median 3. 8) years following electrodiagnosis to determine clinical progress and outcome. In patients with sensory symptoms alone or non-progressive painless motor symptoms, non-operative treatment was commenced. This involved advice on activity modifications and protection with a tubipad bandage or night spin.

12. 9% and 8. 8% of lesions were due to injury and intra-operative pressure respectively. Other causes included deformity and/or synovitis from arthritis of the elbow, repeated pressure, medial epicondylitis and benign space occupying lesions. 58. 2% were idiopathic with no clinical aetiological factor. 22 patients had expected bilateral lesions whereas 15 had contralateral lesions that were not symptomatic. 89. 4% and 4. 7% of lesions occurred at the elbow and wrist respectively. 83% of patients received non-operative first line treatment. 21% of these required operative intervention following further clinical and electrophysiological assessment. Partial or complete recovery occurred in 80%, 67% and 52% of the intra-operative, idiopathic and injury cases respectively (P< 0. 05).

We conclude lesions of the ulnar nerve predominate in males and can be treated non-operatively providing clinical and electrophysiological monitoring is possible. Bilaterality is not uncommon and should be excluded. Lesions due to injury have a worse prognosis than those caused by direct continuous or repeated pressure or where no aetiological factor exists.