Background: Surgical treatment of spinal deformities is complex and is performed by a limited number of spine surgeons. To obtain adequate radiological and clinical correction, a large amount of clinical experience is required when planning corrective surgery because of the enormous amount of patient related variables, and the many surgical techniques (e.g. rod rotation vs translation, pedicle screws vs hooks, anterior vs posterior).

The widely used classification systems (King and Lenke) are useful for documentation of the deformities. Unfortunately explicit guidelines for surgery are not clear. A multi-centre database with pre and postoperative patient data including photographic images and x-rays will be very useful in decision making. It will allow surgeons to find similar cases in the database that will help them in their decision making for surgical planning and execution. Furthermore it will provide extensive data to perform outcome studies, and to develop general treatment guidelines. Surgery for spinal deformities will become more evidence based and less dependent on the individual surgeons judgement.

Methods: A modern web-based database system, Scolisoft was developed for documenting patient data and curve characteristics. The system contains patient data (demographics etc), radiological data (AP, Lat, bending films), classification of curve patterns according to the often-used classification systems and information about the surgical procedure. It includes pre and postoperative radiological data and clinical photographs.

The patient data can also be stored and printed as a PDF-file, so that it can be used as a patient chart and for patient information purposes.

Scolisoft allows the user to select patients based on all the individual characteristics, e.g. curve classification. For pre-operative planning of a specific deformity, a cohort of patients with the same deformity (patient demographics, curve pattern, bending films etc) can be selected and the postoperative results viewed.

With the same selection tool, cohorts of patients can be selected for outcome studies.

Furthermore Scolisoft provides the possibility of discussing difficult cases with other spine surgeons using the system.

Finally, complications are registered according to the existing Scoliosis Research Society complication registry system.

Experiences: Data of more than 200 patients have been entered into the former PC application system. The current web based system has 60 cases that have been entered during its trial phase. Most cases have been adolescent or adult idiopathic scoliosis. Forty two surgeons have used the software and eight surgeons have participated in entering cases. The web-based version has shown to be very user friendly. Submitting the radiological and clinical images is easy (but takes some time). All data input is possible by a simple click of the mouse. Therefore it is relatively easy to learn.

The system already has the possibility for documenting other spine pathology such as sagittal plane deformities, fractures and spondylolisthesis.

Conclusion: Scolisoft is a powerful, user-friendly web-based registry for spinal deformities. It is a very useful tool in planning spinal deformity surgery and research. In this time of evidence-based medicine, it is time to take the planning of scoliosis surgery out of the realm of myth, and this database is a strong step in that direction.

Introduction The purpose of this prospective controlled study was to define indications and analyse the clinical and radiographic results of cages in the surgical treatment of traumatic cervical spine instability.

Methods 53 patients were treated by monosegmental anterior discectomy and interbody fusion using either autologous tricortical iliac crest bone graft and cervical spine locking plate (CSLP) (bone graft group, n= 26) or Syncage-C (Synthes) filled with autologous cancellous bone grafts and CSLP (cage group n=27). Indications for surgery were traumatic cervical spine instability were classified by the cervical fracture classification of Blauth et al¹ as B1, B2, B3, C2 or C3 fractures. Intraoperative parameters (operative time, blood loss radiation time and intra- and perioperative complications) were documented. Prior to surgery and at follow-up (6 and 12 months) evaluation included measurement of neck pain, shoulder/arm pain and Neck Pain Disability Index (NPDI). Neurological function was assessed using the ASIA scale. Radiographic evaluation included plain X-rays, flexion-extension views and CT-scans. Patient satisfaction was measured on a five-point Likert scale.

Results There was no statistically significant difference between the two groups in the demographic data. One patient in the bone graft group was not available for the 1-year follow-up evaluation; however, all patients were available for the 2-year follow-up. Operation time was significantly shorter (p< 0.05) in the cage group (67 +/− 6 min) than in the bone graft group (78 +/− 9 min). After 6 and 12 months there was no difference between both groups in pain or NPDI, neurological and overall outcome. The neurological improvement of the two groups was not statistically different. Although the cage group showed a trend for better maintenance of lordosis after 12 months, there was no statistically significant difference between groups in all radiographic parameters. There were no implant-related complications during the follow-up. General complications included one patient with eczema due to the stiff collar (cage group) and one patient with pneumonia (cage group). Complications associated with the harvesting of iliac crest bone grafts included 14 patients (9 patients in the bone graft group, 5 patients in the cage group) with prolonged pain (> 3 months) at the donor site, one superficial wound healing problem (bone graft group) which healed under conservative treatment and one hematoma (bone graft group) which required additional surgery.

Discussion Cages offer a valid alternative to a tricortical iliac crest bone graft in the surgical treatment of mono-segmental traumatic cervical spine instability. Although there was no significant difference between the cage and the bone graft group in the functional and radiographic outcome, less donor site morbidity and a shorter operation time make cages cost effective in this selected group of patients. Although the cages are expensive, less donor site morbidity, shorter operation time and reduced hospital stay might result in cost-effectiveness of this implant.

Aims: The purpose of this study was to evaluate the clinical and radiological results of expandable titanium cages for vertebral body replacement in a prospective clinical trial. Methods: Since 04/1999 81 patients with thoracolumbar burst fractures underwent posterior stabilisation followed by vertebral body replacement using expandable titanium cages (VBR, Ulrich, Germany) þlled with cancellous bone graft. Postoperatively at 3, 6, 12 and 24 months clinical and radiological evaluation was performed including ßexion/extension views and quantitative CT-scans to assess stability and fusion. Results: Until 09/2002 40 patients had a one year, 12 a two year follow-up. Pain decreased from 62 to 25 on VAS, ROM increased and preoperative neurologic deþcit improved in 25% of patients. Average postoperative loss of lordosis was 5.5 degrees, subsidence of the cages was 4.5 mm. CT scans showed solid bony fusion in 25%, incomplete fusion in 35% and non-fusion in 40% after one year. One patient suffered of left side paralysis of diaphragm, 9 patients of post-thoracotomy-syndrome. Conclusion: With expandable cages a very exact adaptation to the height of the defect and a gradual press þt of the cage and endplates can be achieved. The clinical outcome after one and two years is similar to operative techniques using tricortical iliac crest bone graft or non-expandable cages. However, fusion could not be achieved in 40% of patients after one year.