Background Context

SPECT-CT is a hybrid imaging modality, which has become very well established in the diagnosis of inflammatory, vascular and malignant processes affecting the spine. However, little evidence exists on its application with degenerative pathologies.

To evaluate the incidence of complications and the radiographic and clinical outcomes from 2-stage reconstruction including 3-column osteotomy for revision adult spinal deformity.

A prospective cohort study performed over 2 years at a major tertiary referral centre for adult spinal deformity surgery. All consecutive patients requiring 2-stage corrective surgery for revision adult spinal deformity were included. Radiographic parameters and clinical outcome measures were collected preoperatively and at 6 weeks, 6 months, 1 year and 2 years postoperatively. Radiographic parameters analysed included pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis and sagittal vertical axis. Clinical outcome measures collected included EQ-5D, ODI, SRS 22 and VAS Pain Scores.

Performing anterior column reconstruction followed by 3-column osteotomy and extension of instrumentation for revision spinal deformity resulted an excellent correction of sagittal alignment, minimal surgical complications and significant improvements in HRQOL. Restoration of lumbar lordosis, pelvic tilt and sagittal vertical axis were observed in addition to postoperative improvements in EQ-5D, ODI, SRS 22 and VAS Pain Scores at follow-up.

Performing anterior column reconstruction prior to a 3-column osteotomy minimises complications associated with 3-column osteotomy and extension of posterior instrumentation. We propose a treatment algorithm for safe and effective treatment in revision adult deformity surgery.

Statement of purpose

To analyse the distribution of osteoarthritis of the knee, to determine what proportion of patients may be suitable for a partial knee replacement and finally to assess the risk of wear progression.

It is believed by some that knee radiographs may underestimate the extent of osteoarthritis. Often severe changes are noted at arthroscopic assessment despite the observation of preserved joint spaces on plain radiographs. This has important implications regarding the indications for different types of partial joint replacement if damage is underestimated.

Aims:

To determine the correlation if any between radiographic findings and arthroscopic findings.

Methods and patient selection: The pre-operative radiographs and intra-operative articular surface mappings were collected for 100 consecutive patients undergoing prospectively audited outcome of arthroscopic debridement. All the patients examined were aged 40 and above with knee pain. The intra-operative findings and any work done (debridement of meniscal tears or cartilage flap tears) were also recorded on zoned articular maps and meniscal diagrams. The pre-operative radiographs (AP standing, lateral, Rosenberg and skyline views) were examined and graded using the Kellgren and Lawrence grading system.

Results: Correlations made between arthroscopic findings and AP standing views yielded a sensitivity of 72% and specificity of 64%. The positive predictive value was 91% and negative predictive value was 32%. Rosenberg views were better at predicting the presence of osteoarthritis (sensitivity 76%, specificity 88%, positive predictive value 97%, negative predictive value 44%). Skyline views were found to particularly unreliable in assessment of patello-femoral damage. Analysis of the actual patterns of articular damage found at arthroscopy did show that it is possible to identify cohorts of patients who may in future be suitable for different types of partial replacement.

Conclusions: Radiographs and in particular skyline views are limited in terms of sensitivity and specificity in the prediction of osteoarthritis. Rosenberg views offer better prediction of osteoarthritis compared with weight bearing AP radiographs. Arthroscopy carried out in any event for clinical indications appears to offer useful additional information regarding indications for future surgery.

Statement of purpose: To profile the neurological lesions associated with scoliosis, evaluate the role of preoperative MRI and determine the proportion of patients requiring surgery for an intradural lesion.

Methods: The records of patients undergoing surgery to treat scoliosis over a 5 year period were reviewed as part of this retrospective single centre study.

Results: 1926 patients underwent 2714 procedures to treat scoliosis. 45 patients from this cohort were referred for an opinion regarding at least one of the following neural axis abnormalities: Syrinx (47%); Chiari malformation and cerebellar ectopia (40%); tethered cord (13%); persistent central canal (9%); diastematomyelia (7%); neurofibromata (7%); syndromes other than neurofibromatosis (7%); tumours (4%) and vascular lesions (2%).

18 patients underwent surgery to treat a neural axis lesion: Foramen magnum decompression (12); cord untethering (4) and the surgical treatment of diastematomyelia (2).

Conclusions: The authors believe their series to be the largest to date.

Preoperative MRI scans should extend from the cranio-cervical junction to the sacrum, reflecting the potential locations of neural axis lesions.

Radiologists present at units treating scoliosis should be able to identify both commonly occurring lesions such syrinx and intradural pathology.

A significant proportion of patients required surgery to treat their neural axis lesions. Centres treating patients with scoliosis should therefore have the necessary facilities to treat not only scoliosis but also its associated intradural spinal lesions.

Ethics approval: None Audit

Interest Statement: None