Audit is an important part of surgical practice. Commissioners may use it as evidence of quality assurance. No comprehensive audit exists in spinal surgery. Usage of existing databases is disappointing. We developed an audit database which was comprehensive and gathered patient outcomes. The underlying principles were:

All patients having surgery should enter,

Demographic data, OPCS codes, length of stay and other data were downloaded directly from the hospital information systems. A monthly printout of patients enrolled was provided to the audit coordinator. She was responsible for the collection of clinical outcomes at 6 months, 12 months, and 2 years after surgery. The initial audit involved the Northwest and Mersey Regions. Data from the hospital information systems (HIS) for two years were available for comparison. Unfortunately only two centres gathered clinical outcomes. We have continued to gather data. 380 patients have been enrolled. HIS data are available for all. With varying lengths of follow up, there are 1045 potential clinical outcomes available. Only 8 patients (2%; 8 outcomes, 0.76%) have been lost to follow up. Using this data we are able to compare outcomes between surgeons, between surgical procedures, and see changes over time. As far as we know we are the only centre in the UK able to do this. It is a valuable Clinical Governance tool. We believe that the principles underlying this audit are the only means to obtain comprehensive outcome audit in surgery.

Objectives: 1. To assess the results of early intervention in patients with infantile idiopathic scoliosis. 2. To determine prognostic factors

Design: Retrospective cohort study

Subjects: 16 consecutive patients with infantile idiopathic scoliosis who have completed a serial casting programme

Outcome measures: Curve progression, rib asymmetry and the occurrence of surgery

Results Of 16 patients 6 were male, 5 had plagiocephaly and there were 9 left sided curves. The size of the curve of all except one patient improved by casting – 4 curves resolved completely and a further 4 improved by more than 50%. Sex, the presence of plagiocephaly and the size of the curve did not influence outcome. Rib asymmetry was a negative prognostic sign. Early treatment was associated with a significantly better outcome. One child has had surgical treatment.

Conclusions Most children with infantile idiopathic scoliosis can be improved by serial casting.

Rib asymmetry is confirmed as a negative prognostic sign. Early treatment gives better results.

Objective: This study evaluates the use of the Isola Growing Rod System for scoliosis in a group of skeletally immature patients with predominantly neuromuscular disorders. Our series of patients was unsuitable for definitive anterior and posterior fusion due to poor respiratory function.

Design: We reviewed the case notes and x-rays of eighteen patients who had undergone instrumentation with the Isola Growing Rod System. The Cobb angles on the pre-operative and subsequent post-operative X-rays were measured. Complications were noted.

Subjects: Eighteen children with scoliosis.

Outcome measures: Curve correction and complications.

Results: Two patients had idiopathic scoliosis, four patients had spinal muscular atrophy with the remainder having varied diagnoses. Eight patients were fully ambulant, the remainder being wheelchair bound pre-operatively. The average age at rod insertion was eight years, three months. The average number of lengthenings was four. The mean pre-operative Cobb angle was 76 degrees, the mean most recent Cobb angle 28 degrees. One patient required definitive fusion. Two patients required revision procedures due to implant failure.

Conclusion: Our study shows that progressive scoliosis associated with neuromuscular disorder can be controlled with the growing rod system, thus avoiding both anterior release and the ‘crankshaft’ phenomenon, until the optimal time for definitive spinal fusion.