Introduction Chicken studies implicate pinealectomy within a week of hatching as a cause of scoliosis. The nature of the scoliosis has been demonstrated to be similar to that of human idiopathic scoliosis. Scoliosis was not induced following pinealectomy in Rhesus monkeys (primate model). No human studies have been reported. The aim of this study is to determine if idiopathic scoliosis is associated with treatment for pineal lesions (presumably resulting in pinealectomy) in a human paediatric population.

Methods A medical records search was performed in five Australian States for pineal lesions. Identified patients underwent clinical or radiological evaluation for scoliosis. Pathology varied from germ cell tumour, germinoma, pineoblastoma, teratoma to a pineal cyst and an epidermoid cyst. Treatment ranged from biopsy/ extirpation to radiotherapy/chemotherapy.

Results Of 48 identified patients, thirteen are deceased. No scoliosis was present in the last imaging of the deceased. The mean age at presentation was 9.7 years (range 1–18 years). Ten are female. Two males have idiopathic scoliosis (4.2%). One has a 12° right upper thoracic curve (with 32° kyphosis) and the other has a 60° right thoracolumbar curve, requiring a two-stage arthrodesis

Discussion Although the incidence of idiopathic scoliosis in this cohort is greater than expected from Caucasian population studies (2–3%), it is not typical idiopathic-type, which has a female preponderance of larger deformities. New-born chicken studies demonstrate an incidence of between 50 and 100% scoliosis in the three months following pinealectomy. Chickens of both sexes are involved. Fundamental differences exist between chicken and human/primate models including the age at pinealectomy and the anatomical site of the pineal gland. Chickens have a naturally lordotic thoracic spinal curvature whilst humans/primates have a naturally kyphotic thoracic spine. Adolescents with idiopathic scoliosis have either thoracic hypokyphosis or a thoracic lordosis. Contrary to current beliefs, no causal link can be established between pineal lesions and the development of idiopathic scoliosis in a paediatric population.

Introduction Delayed puberty and delayed skeletal maturation have been implicated as risk factors for the progression of idiopathic scoliosis. Genetic defects (Turner syndrome) and hypothalamic- pituitary disorders are known causes of delayed puberty. Although it is recognized that the incidence of idiopathic scoliosis is elevated in Turner syndrome, human studies regarding the incidence/severity of scoliosis in children with suprasellar, hypothalamic region and pituitary tumours/ disorders is deficient.

Methods A medical records search in five Australian states for suprasellar, hypothalamic region and pituitary tumours/disorders was performed. Identified patients underwent clinical or radiological evaluation for scoliosis. Pathology varied from suprasellar-hypothalamic region tumours, pan-hypopituitarism, pituitary tumours and growth hormone deficiency as well as a craniopharyngioma, arachnoid cyst, retinoblastoma and encephalocele.

Results Of 23 identified patients, ten are female. Mean age at presentation was 8.4 years. Three have right thoracic scoliosis with a Cobb angle less than 20 degrees. Two are males; one with pituitary hormone deficiency and the other with Cushing’s disease treated with radiotherapy. The only female is on a growth hormone treatment program for idiopathic growth hormone deficiency.

Discussion The only female with scoliosis was 12 years old. Delayed puberty could not be linked to either male with scoliosis. Although the incidence of idiopathic scoliosis in this cohort is greater than expected from Caucasian population studies (2–3%), the male preponderance is unusual. No relationship between delayed skeletal maturation and idiopathic scoliosis could be established.

Introduction: Patients with malignant spinal disease who have neurologic symptoms are often considered poor surgical candidates. The aim of this paper is to review the effect on neurologic symptoms of surgical management of malignant spinal disease.

Methods: A retrospective review of patients treated from January 1993 to June 2003 was undertaken. Pain status was assessed using patient statements and recorded analgesic requirements. Neurologic symptoms were assessed using Frankel’s grading.

Results: There were 95 patients (32 females aged 26–83; 63 males aged 15–89). No patients were asymptomatic. 61 of 109 presentations were with multiple symptoms. The most common symptom was pain (99) – either localised (8), non-specific back (56) and/or radicular (57). The next most frequent symptom was weakness (54). The time course of onset varied from acute ward deterioration, with urgent surgery, to slow progression over weeks, prior to elective surgery. 8 cases had sphincteric dysfunction.

There were 98 tumours treated. In females, the most common tumours were breast (8) and renal (4) and in males, prostate (13), multiple myeloma (12) and lung (10). The thoracic spine was involved in 62, the lumbar in 18, cervical in 16 and sacral in 2. The vertebral body was involved in 76.

There were 109 operations. An instrumented fusion was performed in 82. Surgical approach was anterior in 17 (9 cervical, 8 thoracic) and posterior in 80 (5 cervical, 56 thoracic and 17 lumbar). Six patients had combined approaches (2 cervical, 3 thoracic and 1 lumbar). Two patients were treated for metachronous tumours. One patient had non-contiguous metastases treated separately. One patient was treated for local recurrence. One patient had revision for implant failure (anterior thoracic). One patient was explored after deterioration due to loss of autoregulation. Thoraco-abdominal approaches (12) were associated with ileus (2) and pneumonia (3). Of four cases with deep wound infections, three had received prior local irradiation. Two patients died of pulmonary embolus. 83 patients survived beyond three months.

All patients demonstrated improvement in pain status. Thirteen of 29 non-ambulatory cases were able to mobilise postoperatively. There were 32 whose Frankel grades improved. Seventeen of these returned to normal (15 from Grade 4 and 2 from Grade 3). One patient with complete motor and sensory loss improved to useful but subnormal status, three others improved to residual motor function. 11 other patients improved one grade. Of those whose scores did not change (76), 53 remained normal, eight maintained useful but subnormal status, five were stabilised with residual motor function, three kept some sensory perception and two had complete motor and sensory loss. One patient deteriorated from residual motor function to complete motor loss. The outcome for sphincter dysfunction (8) was not clear from the notes. In no case was a specific change in function documented.

Discussion: Surgical treatment of malignant spinal tumours is worthwhile. Posterior approaches are versatile and should be considered. Surgery is effective in the management of pain and preserves or may significantly improve neurologic function.

Introduction: The management of cervical spine fracture, subluxation or dislocation in the elderly may present difficulties in decision-making. Frequently, the elderly suffer from medical comorbidity and a limited physiological reserve, which need to be considered in deciding on surgical versus conservative management of fractures and dislocations. Debate exists regarding the merits of surgical versus nonsurgical management of these injuries.^1,2,4

Methods: Retrospective analysis of 16 patients with traumatic cervical spine fractures with or without dislocation or subluxation in patients greater than 65 years of age, spanning 1994 to the present were carried out. Success of spine stabilisation, time in hospital, ability to return to pre-injury function and medical or surgical complications were measured.

Results: The average age of the patients was 76 years with a range of 67–86 years of age. A variety of cervical injuries and fixation methods were identified, the most common injury being odontoid fracture requiring transarticular screw fixation. One patient died eight days post-operatively of cardiac arrest and a second patient died of pneumonia. One other complication of wound hematoma while the patient was taking anticoagulation therapy occurred. All other patients were discharged independent in activities of daily living. There were no cases of failure of surgery to restore stability. No post-operative neurological deterioration in any of the patients occurred.

Discussion: This study shows that surgical fixation of cervical fractures in the elderly can be performed as a safe and efficient form of management. Surgery decreases the period of both immobility and hospitalisation with subsequent decrease in the risk of complications such as deep vein thrombosis, pulmonary embolism and pneumonia³.Complications from immobilisation devices such as the halo-thoracic brace may also be avoided.