Purpose of the study: In spina bifida, independently of limb paralysis, spinal deformation can cause significant static disorders (scoliosis, kyphosis, or hyperlordosis) which in turn cause significant disability. These deformations generally develop during growth. We wanted to determine the predictive value of a clinical classification based on the neurological examination at five years for risk of spinal deformation.

Material: This retrospective study included 163 patients. Groups were defined on the basis of motor function determined by the neurological examination at five years: group I: L5 or below (all patients in this group had motor deficit leaving at least one L5 segment intact); group II: L3–L4; group III: L1–L2; group IV: T12 and above.

Results: Results showed that group I was a factor predictive of an absence of future spinal deformation. Groups III and IV were predictive of presence of a future spinal deformation. Group IV was predictive of future kyphosis.

Discussion: It is well known that the higher the neurological lesion in spina bifida, the higher the rate of spinal deformation. No work has however set the limits nor provided predictive rules useful in clinical practice. Our work demonstrated that this classification based on the motor function established by neurological examination at five years can predict which children have a risk of developing a spinal deformation and thus enabling early detection and treatment.

Conclusion: This neurological classification can be used as a clinical tool for the prognostic evaluation of spina bifida.

Introduction: With the evolution and the complexity of the treatments in cerebral palsy (CP) patients it is essential to assess their outcome using validated tools. Technical analysis offers objective data which may be associated to more subjective functional evaluation and health related quality of life tests. Simplified visual tests were proposed as an alternative to the complex and expensive instrumented three-dimensional gait analysis. The Edinburgh Visual Gait Score (EVGS) was proposed for routine clinical use when complete technical analysis is not available or may represent a part of a global patient evaluation.

The purposes of our study were: 1) to apply a French translation of the EVGS to standard video recordings of a group of independent walking spastic diplegic CP patients 2) to evaluate the intraobserver and interobserver reliability and 3) to compare the results of gait analysis with experienced and inexperienced observers.

Material & methods: A series of ten standard video recordings of spastic diplegic CP patients, acquired during routine clinical gait analysis were examined by eight observers, two times, with two weeks in between the assessments. Observers were selected from following specialties: three paediatric orthopaedic surgeons, one resident in orthopaedic surgery, one neurosurgeon, one physiatrist and two physiotherapists. Observers were separated into two groups according to their experience with gait analysis interpretations. Kappa statistics and intraclass correlation coefficient were calculated.

Results: Better intraobserver and interobserver reliability was observed for foot and knee scores with significant difference between stance and swing phase results. Pelvis, hip and trunk score results were significantly lower. The interobserver reliability for segment scores and the global EVGS showed better results than the intraobserver reliability. The gait analysis experienced observer group showed significantly higher intraobserver and interobserver reliability.

Discussion & conclusion: Our reliability results about the use of the EVGS are close to the results of Read et al. Interestingly we showed a significant difference between the two observer groups. Observers familiar with gait analysis obtained better reliability results. That shows the importance to either be used to clinical gait analysis interpretation including learning the visualisation of the different gait phases, or to benefit of a video analysis training before using the visual score as a standard clinical evaluation tool. For this study we did not use the patient preparation recommendations of the initial authors to improve accuracy of scoring because the possibility to use historic standard videos wanted to be tested. Poor score reliability of the pelvis and hip may be improved. Further studies of multilevel surgery outcome evaluation by visual analysis trained observers are needed to explore clinical changes in CP patients over time.

Purpose: The purpose of this work was to present the long-term outcome after resection of thoraco-lumbar, lumbar, or lumbosacral hemivertebrae in 69 children.

Material and methods: Sixty-nine children (35 girls and 34 boys) underwent surgery at a mean age of 3 years (range 1 year – 10 years 6 months). Mean follow-up was 6 years (range 6 months – 18 years). Resections involved thoracolumbar (n=20), lumbar (n=34), and lumbosacral (n=15) hemivertebrae. Congenital vertebral and visceral malformations were present in 32% and 41% of the children respectively. Ten patients had an underlying neurological malformation.

A single operation was performed in 60 patients using a combined anterior and posterior approach and convex posterior CD baby instrumentation. Nine patients underwent two operations one week apart. All patients wore a corset brace for six months.

Results: Structure curvature: the mean Cobb angle was 35° preoperatively, 16° postoperatively, and 15° at last follow-up.

Compensating curvature: the mean Cobbe angle was 21° preoperatively and 12° at last follow-up. Complications: partial deficit of the anterior tibialis (n=1), nonunion (n=3), infection (n=1), disassembly (n=3), valgum tibia at the site of the fibular graft harvesting (n=1).

Discussion: At these spinal levels, hemivertebral resection appears to be the most appropriate technique for children aged less than three years as long as there are no clear signs of progressive curvature.

Among two hundred and twenty hemivertebrae in our files we performed over a period of eighteen years sixty nine hemivertebrae (HV) excision. Only H.V. with evidence of curve progression were operated on. The technique was a one stage anterior and posterior approach plus convex anterior and posterior arthrodesis plus convex posterior instrumentation using in the more recents cases a baby C.D.

Material: The location of the H.V. was thoraco-lumbar in twenty five cases, lumbar in twenty nine and lumbo-sacral in fifteen. Thirty two free, thirty six hemifused and only one fused H.V. were operated on. The sex ratio was 35 males and 34 females. Associarted malformations were numerous. If the rate of visceral associated malformations is rather the same whatever was the location of the H.V. ( 40% ) the number of associated spine malformations decrease from cranial to caudal ( 60% for thoraco-lumbar H.V. versus 13 % for lumbo-sacral H.V.) The mean age at surgery was 3Y 3M ( 1Y- 9Y) with a mean F.U. of 5Y ( 6M-18Y) for the 25 thoraco-lumbar H.V., respectively 3Y3M ( 1Y- 8Y3M) for the mean age at surgery and 5Y ( 1M-17Y5M) for the average F.U.for the 29 lumbar H.V. and 5Y1M (1M-10Y4M) for surgery and 7Y (1M-18Y3M) for F.U. for the remaining 15 lumbo-sacral H.V.

Results: 8 complications were encountered: 4 hardware failures, 1 sepsis, 1 transient paresthesia of the tibial nerve, 1 partial loss of power in the tibialis anterior and 1 valgus deformity following fibular bone grafting. For the 25 thoraco-lumbar H.V. the average scoliosis Cobb angle pre operatively was 38° ( 18°/ 75°) and at F.U. 24° ( 0°/ 76°) . The mean kyphosis Cobb angle was 24° ( -20°/ 54°) pre operatively and 25° (-16°/60°) at F.U. For the 29 lumbar H.V. the mean scoliosis Cobb angle was 35° (16°/58°) pre operatively and 10° (0°/38°) at F.U.The average kyphosis Cobb angle was -2°( -45°/20°) pre operatively and -6° (-42°/22°) at F.U. For the remaining 15 lumbo-sacral H.V. the average scoliosis Cobb angle was 30° (18°/40°) pre operatively and 13° (2°/32°) at F.U. The mean kyphosis Cobb angle was -22°(-54°/0°) pre operatively and -25°(-64°/-8°) at F.U. H.V. excision is in our opinion the best procedure to treat thoraco-lumbar,lumbar and lumbo-sacral H.V. as far as there is evidence of curve progression. The appropriate age to perform this kind of surgery is before three years of age.