Study Design: observational study over time

Objectives: 1. To investigate the effect of right and left radiculopathy on driver brake-reaction time (DBRT) 2. Determine the effect of selective nerve root block (SNRB) on DBRT

Summary of Background Data: DVLA guidelines for fitness to drive after orthopaedic procedures remain vague. DBRT has been assessed using different driving simulators in several surgical and non-surgical conditions. To date the effect of sciatica and SNRB on DBRT has not been studied.

Methods: DBRT s of 20 patients with sciatica (10 right, 10 left) were measured using a custom-built car simulator. Each patient was tested pre-SNRB, immediate post-SNRB, 2 and 6 weeks post-SNRB. As controls 20 age-matched normal subjects were tested once. Full departmental, institutional and ethical committee approval were obtained.

Results: The mean reaction time of the control group was 459 ms. The mean reaction times of the patients at different points of assessment were as follow:

Conclusions:

This study confirms the intuitive impression that patients with sciatica have prolonged DBRT compared to normal population. This represents an extra absolute increase in traveling distance of 2.4 meters in a 70 mph speed zone.

Study design: A retrospective review of patient records with recent clinical and radiographic assessment.

Objective: Long-term evaluation of the Luque trolley for posterior instrumentation in congenital scoliosis.

Summary of background data: From a group of 51 cases treated with the Luque trolley, we review 10 patients with progressive congenital scoliosis (5male, 5female) for a mean follow-up period of 14.8 years, to mean age of 19 years. The mean Cobb angle of the primary curve before surgery was 69.5 degrees. The mean Cobb angle of the secondary cervico-thoracic curve before surgery was 37.1 degrees and of the caudal secondary curve was 26.4 degrees. The mean age at surgery was 5.0 years. 8 patients had a selective epiphysiodesis procedure, 2 with hemi-vertebrectomy, and all underwent single- stage (7 patients) or dual-staged (3 patients) posterior instrumentation with a Luque trolley growing construct.

Method: Clinical evaluation and sequential measurements of Cobb angle were done, with recording of further surgical procedures, associated complications, and final coronal balance. The thoracolumbar longitudinal spinal growth (T1-S1) and growth in the instrumented segmented were also calculated.

Results: The mean preoperative primary curve Cobb angle of 69.5degrees, corrected to a mean postoperative angle of 30.6 degrees, with progression from here to curve magnitude of 38.8 degrees on latest follow up (approximate rate of progression of 0.55 degrees per year).

The mean pre-operative cephalic (cervico-thoracic) Cobb angle of 37.1degrees, corrected to 22 degrees, with progression to 26.6 degrees.

The mean pre-operative caudal (lumbar) Cobb angle of 26.4degrees, corrected to16.2 degrees, this later progressed to 20.6 degrees.

Coronal plane translation measured 1.68 cm at latest follow up [range 0.5–5.1cm].

The thoracolumbar longitudinal growth measured a mean of 8.81cm (approx0.8 cm/year) with a recorded lengthening of 2.54 cm (approx 0.23cm/year) in the instrumented segmented. Half the patients did not require further surgery.

Conclusion: Selective fusion does not always prevent further deformity in congenital scoliosis. The addition of posterior growing construct instrumentation did demonstrate capacity for good correction of primary and secondary curvatures and a limited capacity for further longitudinal growth.