The December 2022 Children’s orthopaedics Roundup³⁶⁰ looks at: Immobilization of torus fractures of the wrist in children (FORCE): a randomized controlled equivalence trial in the UK; Minimally invasive method in treatment of idiopathic congenital vertical talus: recurrence is uncommon; “You’re O.K. Anaesthesia”: closed reduction of displaced paediatric forearm and wrist fractures in the office without anaesthesia; Trunk range of motion and patient outcomes after anterior vertebral body tethering versus posterior spinal fusion: comparison using computerized 3D motion capture technology; Selective dorsal rhizotomy for individuals with spastic cerebral palsy; Scheuermann’s kyphosis and posterior spinal fusion; All-pedicle-screw constructs in skeletally immature patients with severe idiopathic early-onset scoliosis; Proximal femoral screw hemiepiphysiodesis in children with cerebral palsy.

To compare preoperative and postoperative Health Related Quality of Life (HRQoL) scores in operated Adolescent Idiopathic Scoliosis (AIS) patients with and without concomitant isthmic spondylolisthesis. A retrospective study of a prospective cohort of 464 individuals undergoing AIS surgery between 2008 and 2018 was performed. All patients undergoing surgery for AIS with a minimum 2-year follow-up were included. We excluded patients with prior or concomitant surgery for spondylolisthesis. HRQoL scores were measured using the SRS-22 questionnaire. Comparisons were performed between AIS patients with vs. without concomitant spondylolisthesis treated non-surgically. AIS surgery was performed for 36 patients (15.2 ±2.5 y.o) with concomitant isthmic spondylolisthesis, and 428 patients (15.5 ±2.4 y.o) without concomitant spondylolisthesis. The two groups were similar in terms of age, sex, preoperative and postoperative Cobb angles. Preoperative and postoperative HRQoL scores were similar between the two groups. HRQoL improved significantly for all domains in both groups, except for pain in patients with spondylolisthesis. There was no need for surgical treatment of the spondylolisthesis and no slip progression during the follow-up duration after AIS surgery. Patients undergoing surgical treatment of AIS with non-surgical management of a concomitant isthmic spondylolisthesis can expect improvement in HRQoL scores, similar to that observed in patients without concomitant spondylolisthesis

Aims

To report the surgical outcome of patients with severe Scheuermann’s kyphosis treated using a consistent technique and perioperative management.

Scheuermann's kyphosis is a structural deformity of the thoracic or thoracolumbar spine, which can result in severe pain, neurological compromise and cosmetic dissatisfaction. Modern surgical techniques have improved correction through a posterior-only or antero-posterior approach but can result in significant morbidity. We present our results of the surgical management of severe Scheuermann's kyphosis by a single surgeon with respect to deformity correction, global balance parameters, functional outcomes and complications at latest follow-up. We included 49 patients, of which 46 had thoracic and 3 had thoracolumbar kyphosis. Surgical indications included persistent back pain, progressive deformity, neurological compromise and poor self-image. Fourty-seven patients underwent posterior-only and 2 antero-posterior spinal arthrodesis utilising Chevron-type osteotomies and hybrid instrumentation. Mean age at surgery was 16.0 years with mean postoperative follow-up of 4.5 years. Mean kyphosis corrected from 92.1o to 46.9o (p<0.001). Concomitant scoliosis was eliminated in all of the 28 affected patients. Coronal and sagittal balance was corrected in all patients. Mean blood loss was 24% total blood volume. Mean operation time was 4.3 hours with mean inpatient stay of 9 days. SRS-22 questionnaire improved from a mean preoperative score of 3.4 to 4.6 at 2 years, with high treatment satisfaction rates. Complications included one toxic septicaemia episode but otherwise no wound infections, no junctional deformity, no loss of correction and no requirement for re-operation. Posterior spinal arthrodesis with the use of hybrid instrumentation can safely achieve excellent correction of severe Scheuermann's kyphosis helping to relieve back pain, improve functional outcomes and enhance self-image

The SRS-22 instrument was developed to assess quality of life in adolescent idiopathic scoliosis patients (AIS). The aim of our study was to evaluate the impact of surgical treatment on quality of life in neurologically normal patients with complex spinal deformity of a range of aetiologies using the SRS-22 questionnaire. We analysed prospectively collected SRS-22 data on 407 consecutive patients (315 females-92 males) treated from 2006–2012 under the care of the senior author. 97.6% of patients had a posterior (PSF), 1.3% an anterior (ASF) and 1.1% an anterior-posterior (A/PSF) spinal fusion. Questionnaires were completed at 4 stages of treatment: preoperatively, 6-months, 12-months and 24-months postoperatively. Other variables included age at surgery, gender, diagnosis and year of surgery. 9 diagnoses were included in the study: 271 patients had AIS; 39 Scheuermann's kyphosis; 31 spondylolisthesis; 16 congenital scoliosis; 13 JIS; 6 IIS; 13 scoliosis associated with intraspinal anomalies; 11 syndromic scoliosis; 7 scoliosis associated with congenital cardiac disease. Mean age at surgery was 15.14±2.07 years. Age at surgery was divided in 3 groups to compare outcomes against previous studies: 10–12, 13–15, and 15–19 years. Mean total SRS-22 scores for the whole group were: preoperative 3.62±0.66; 6-month 4.12±0.44; 12-month 4.39±0.40; and 24-month 4.52±0.37 (p<0.0001). Individual preoperative scores for the whole group were: function 3.77±0.75; pain 3.7±0.97; self-image 3.14±0.66; mental 3.86±0.77. Mean 24-month postoperative scores for the whole group were: function 4.39±0.42; pain 4.59±0.56; self-image 4.39±0.51; mental 4.43±0.56; satisfaction 4.81±0.40. All changes observed at 2-year follow-up were statistically significant (p<0.0001). Male preoperative total score (3.64±0.66) did not have a significant difference compared to female (3.62±0.66); however 24-month total score improvement was significant, with males (4.62±0.25) performing better than females (4.49±0.39) including satisfaction (p=0.004). Spondylolisthesis patients performed worse preoperatively (2.93±0.26) compared to other diagnoses (p<0.0001); AIS 3.67±0.64, congenital 3.81±0.57, syndromic 3.80±0.54, Scheuermann's 3.48±0.75, JIS 3.90±0.63, scoliosis with congenital cardiac disease 4.04±0.41 or intraspinal anomalies 3.71±0.66, and IIS 3.58±0.80. No change in total and individual scores was observed at 24-month review across diagnoses (p>0.05). There were no significant changes between each year of surgery in the study period and the total values at each stage (p>0.05). There were no significant changes between the 3 age ranges at each stage (p>0.05). Patients undergoing ASF performed significantly better at preoperative function (4.7±0.27) compared to PSF (3.76±0.74) and A/PSF (3.68±0.72), (p=0.19). All values at 2-years were not significant in comparison regarding type of operation (p>0.05). All individual domains and total SRS-22 scores improved after surgical correction of spinal deformity in our young patient cohort with an incremental change between preoperative, 6-month, 12-month and 24-month postoperative. Our 24-month postoperative outcomes in all diagnoses compare favourably to reported SRS-22 scores in healthy adolescents (function: 4.31±0.54; pain: 4.44±0.67; image: 4.41±0.64; mental health: 3.96±0.81; total 4.26±0.54). We are planning to continue this study with longer follow-up in order to allow comparison of our SRS-22 outcomes after surgical treatment to those obtained in patients treated with bracing or patients who were followed untreated (previous reports SRS-22 total scores: 4.2 for braced patients and 4.1 for observed patients)

Clinical, radiological, and Scoliosis Research Society-22 questionnaire data were reviewed pre-operatively and two years post-operatively for patients with thoracolumbar/lumbar adolescent idiopathic scoliosis treated by posterior spinal fusion using a unilateral convex segmental pedicle screw technique. A total of 72 patients were included (67 female, 5 male; mean age at surgery 16.7 years (13 to 23)) and divided into groups: group 1 included 53 patients who underwent fusion between the vertebrae at the limit of the curve (proximal and distal end vertebrae); group 2 included 19 patients who underwent extension of the fusion distally beyond the caudal end vertebra.

A mean scoliosis correction of 80% (45% to 100%) was achieved. The mean post-operative lowest instrumented vertebra angle, apical vertebra translation and trunk shift were less than in previous studies. A total of five pre-operative radiological parameters differed significantly between the groups and correlated with the extension of the fusion distally: the size of the thoracolumbar/lumbar curve, the lowest instrumented vertebra angle, apical vertebra translation, the Cobb angle on lumbar convex bending and the size of the compensatory thoracic curve. Regression analysis allowed an equation incorporating these parameters to be developed which had a positive predictive value of 81% in determining whether the lowest instrumented vertebra should be at the caudal end vertebra or one or two levels more distal. There were no differences in the Scoliosis Research Society-22 outcome scores between the two groups (p = 0.17).

In conclusion, thoracolumbar/lumbar curves in patients with adolescent idiopathic scoliosis may be effectively treated by posterior spinal fusion using a unilateral segmental pedicle screw technique. Five radiological parameters correlate with the need for distal extension of the fusion, and an equation incorporating these parameters reliably informs selection of the lowest instrumented vertebra.

Cite this article: Bone Joint J 2014;96-B:1082–9.

Introduction. Monitoring of scoliosis is traditionally done with radiographs, which can be associated with an increased risk of cancer secondary to multiple exposures over many years. This study investigated whether the findings from surface topography can be used to monitor scoliosis curves and how much this method affects outcome scores in patients with scoliosis. This study therefore had two subsets: (1) to investigate whether lateral asymmetry (LA) from ISIS2 surface topography can predict radiographic Cobb angle, providing an alternative non-invasive means of monitoring patients with scoliosis (LA and Cobb subset); and (2) to establish the relationships between the magnitude of the deformity in scoliosis, measured by Cobb angle on radiograph and volumetric asymmetry (VA) with the ISIS2 surface topography, and the patient perception of self-image and mental health, measured with SRS-22 scores (Cobb, VA, and SRS subset). Methods. In the LA and Cobb subset, 72 untreated patients with scoliosis (77 curves) with a Cobb angle of 55° or less were included in the study. They had clinical assessment, Cobb angle measurement taken from a standard radiograph, and surface topography done on the same day. A comparison of Cobb angle and LA was done. In the Cobb, VA, and SRS subset, 89 untreated patients with scoliosis were included in the study. They had clinical assessment, Cobb angle measurement of radiograph, and surface topography done on the same day along with SRS-22 questionnaires. A comparison correlation of SRS scores for function, pain, self-image, and mental health against Cobb angle and VA was undertaken. All statistical analysis was done with software R. Results. In the LA and Cobb subset, for Cobb angle less than 55° on radiograph, ISIS2 was able to predict the Cobb angle within 13°. In the VA, Cobb, and SRS subset, Cobb angle contributed only about 10% to self-image, whereas VA contributed 14%. Cobb angle contributed about 6·2% to mental health, whereas VA contributed 8·6%. Conclusions. Cobb angles display poor reliability, with estimates ranging from 3° to 10°. Even so, the 95% CIs on the prediction of Cobb angle from ISIS2 LA are too wide to use it alone to monitor spinal curvature. Whether or not LA is capable of monitoring change in curvature will be investigated as more longitudinal data are built up. VA correlates better with both mental health and self-image than does Cobb angle, but the correlation is still poor. Neither Cobb angle nor VA can be used to predict patient's self-image or mental health. We are pursuing this study further to look at other parameters that may affect SRS-22 such as sex, age, type of deformity, waist asymmetry, and shoulder asymmetry

Purpose of the study. To establish the relation between the magnitude of the deformity in scoliosis, measured by cobb angle on radiograph & Volumetric asymmetry with the ISIS2 surface topography, and the patient perception of self image and mental health, measured with SRS-22 scores. Methodology. A total of 89 untreated patients with scoliosis were included in the study. They had clinical assessment, cobb angle measurement of radiograph and surface topography performed on the same day along with SRS-22 questionnaires. The cobb angle was measured by single surgeon using a digital PACS system, who was unaware of the volumetric asymmetry score. Volumetric asymmetry was measured by ISIS2 surface topography performed by a research nurse who was unaware of the cobb angle. Volumetric asymmetry was calculated using standard ISIS2 software. A comparison correlation of SRS scores for function, pain, self image and mental health against cobb angle and volumetric asymmetry was undertaken by clinical scientist. Scores for patient satisfaction to treatment was excluded as these were untreated patients. Statistical analysis was performed using cor. test on software R. Results. Correlation of both cobb angle and volumetric asymmetry for function and pain were statistically not significant (p value > 0.05). However for self image, correlation was statistically significant with cobb angle (p value-0.0033) and volumetric asymmetry (p value-0.00031), but the correlation was not high. Cobb angle contributed only around 10% to self image, whilst volumetric asymmetry contributed only 14%. Similarly for mental health, correlation was statistically significant with cobb angle (p value-0.0194) and volumetric asymmetry (p value-0.00559), but the correlation was not high. Cobb angle contributed only around 6.2% to mental health, whilst volumetric asymmetry contributed only 8.6%. Conclusion. Volumetric asymmetry correlates better to both mental health and self image as compared to cobb angle, but the correlation is still poor. Neither cobb angle or volumetric asymmetry can be used to predict patients self image or mental health. We are pursuing this study further to look at other parameters which may affect SRS-22 such as gender, age, type of deformity, waist asymmetry and shoulder asymmetry. Ethics approval: None. Interest Statement: None

Our prospective observational study of patients treated for Thoracolumbar Adolescent Idiopathic Scoliosis (AIS) by anterior instrumentation aimed at investigating the correlation between the radiographic outcome and the recently-developed scoliosis research society self-reported outcomes instrument (SRS-22) which has been validated as a tool for self-assessment in scoliosis patients. Previous patient based questionnaires demonstrated poor correlation with the radiological parameters. Materials and Methods. Pre-operative, post-operative and two years follow-up radiographs of 30 patients were assessed. Thirteen radiographic parameters including Cobb angles and balance were recorded. The percentage improvements for each were noted. The SRS-22 questionnaire was completed by all patients at final follow-up. Correlation was sought between each radiographic parameter, total SRS score and each of the five domains by quantifying Pearson's Correlation Coefficient (r). Results. Percentage improvement in primary Cobb angle (r = 0.052), secondary Cobb angle (r = 0.165), apical vertebra translation of the primary curve (r = -0.353), thoracic kyphosis (r = 0.043) and lumbar lordosis (r = 0.147) showed little or no correlation with the SRS-22 total score and its five individual domains. Significant inverse correlation was found between the upper instrumented vertebra angle and at follow-up and SRS-22 (r = -0.516). The same was true for Sagittal plumb line shift at final follow up (r = -0.447). Conclusion. SRS-22 is a validated tool for the self-assessment of health status in spinal deformity patients; however, it does not seem to correlate with most of the radiographic parameters commonly used by clinicians to assess patient outcome with the exception of upper instrumented vertebra angle and sagittal plumb line which do correlate significantly with the SRS-22 outcomes instrument. A comprehensive system of assessing the success of surgery both from the patient and clinicians perspective is required in the spinal deformity patient

The SRS-22 is a valid instrument for the assessment of the health related quality of life of patients with Idiopathic scoliosis. The purpose of this study is to evaluate the reliability and validity of the adapted Greek version of the refined Scoliosis Research Society-22 Questionnaire. Following the steps of cross – cultural the adapted Greek version of the SRS-22 questionnaire and a validated Greek version of the SF-36 questionnaire were mailed to 68 patients treated surgically for Idiopathic Scoliosis with a mean age at the time of operation 16.2 years and a mean age at the time of evaluation 21.2 years respectively. A 2nd set of questionnaires was mailed in 30 patients within 30 days from the 1st set. Reliability assessment was determined by estimating Cronbach’s a and intraclass correlation coefficient (ICC) respectively. Concurrent validity was evaluated by comparing SRS-22 domains with relevant domains in the SF-36 questionnaire using Pearson’s Correlation Coefficient (r). The calculated Cronbach’s a of internal consistency for three of the corresponding domains (pain 0.85; mental health 0.87; self image 0.83) were very satisfactory and for two domains (function/activity 0.72 and satisfaction 0.67) were good. The ICC of all domains of SRS-22 questionnaire was high (ICC> 0.70). Considering concurrent validity all correlations demonstrated high correlation coefficient. The adapted Greek version of the SRS-22 questionnaire is valid and reliable and can be used for the assessment of the outcome of the treatment of the Greek speaking patients with idiopathic scoliosis

Introduction: Patient questionnaires permit a direct measure of the value of care as perceived by the recipient. The Scoliosis Research Society outcomes questionnaire (SRS-22) has been validated as a tool for self-assessment. We investigated the correlation between SRS-22 and a detailed radiological outcome two years following anterior correction of Thoraco-Lumbar Adolescent Idiopathic Scoliosis (TL-AIS). Methods: The SRS-22 questionnaire was completed by 30 patients two years following anterior correction of TL-AIS. Pre-operative, post-operative and two year follow-up radiographs of all 30 patients were assessed. The following parameters were measured at each time point:. Primary Cobb angle,. Secondary Cobb angle,. Coronal C7-midsacral plumb line,. Apical Vertebra Translation (AVT) of primary curve,. AVT of the secondary curve,. Upper instrumented vertebra (UIV) translation,. UIV tilt angle,. Lower instrumented vertebra (LIV), 8) LIV tilt angle. Apical Vertebra Rotation (AVR) of the primary curve,. Sagittal C7-posterior corner of sacrum plumb line. T5-T12 angle,. T12-S1 angle,. shoulder height difference. The percentage improvements for each were noted. Correlation was sought between Total SRS score, each of the five individual domains and various radiographic parameters listed above by quantifying Pearson’s Correlation Coefficient (r). Results: Percentage improvement in primary Cobb angle (r = 0.052), secondary Cobb angle (r = 0.165) and AVT of the primary curve (r = −0.353) showed little or no correlation with the SRS-22 total score or any of its five domains. Significant inverse correlation was found between the UIV tilt angle at two years and the SRS-22 (r = −0.516). Lateral radiographs however showed little or no correlation between thoracic kyphosis (r = 0.043) and SRS-22. Conclusion: The SRS-22 outcomes questionnaire does not correlate with most of the radiographic parameters commonly used by clinicians to assess patient outcome

Introduction: Patient questionnaires permit a direct measure of the value of care as perceived by the recipient. The Scoliosis Research Society outcomes questionnaire (SRS-22) has been validated as a tool for self-assessment. We investigated the correlation between SRS-22 and a detailed radiological outcome two-years following anterior correction of ThoracoLumbar Adolescent Idiopathic Scoliosis (TL-AIS). Methods: The SRS-22 questionnaire was completed by 30 patients two-years following anterior correction of TL-AIS. Pre-operative, post-operative and two-year follow-up radiographs of all 30 patients were assessed. The following parameters were measured at each time point: 1) Primary Cobb angle, 2) Secondary Cobb angle, 3) Coronal C7-midsacral plumb line, 4) Apical Vertebra Translation (AVT) of primary curve, 5) AVT of the secondary curve, 6) Upper instrumented vertebra (UIV) translation, 7) UIV tilt angle, 8) Lower instrumented vertebra (LIV), 8) LIV tilt angle 9) Apical Vertebra Rotation (AVR) of the primary curve, 10) Sagittal C7-posterior corner of sacrum plumb line 11) T5–T12 angle, 12) T12-S1 angle, 13) shoulder height difference. The percentage improvements for each were noted. Correlation was sought between Total SRS score, each of the five individual domains and various radiographic parameters listed above by quantifying Pearson’s Correlation Coefficient (r). Results: Percentage improvement in primary Cobb angle (r = 0.052), secondary Cobb angle (r = 0.165) and AVT of the primary curve (r = −0.353) showed little or no correlation with the SRS-22 total score or any of its five domains. Significant inverse correlation was found between the UIV tilt angle at two years and the SRS-22 (r = −0.516). Lateral radiographs however showed little or no correlation between thoracic kyphosis (r = 0.043) and SRS-22. Conclusion: The SRS-22 outcomes questionnaire does not correlate with most of the radiographic parameters commonly used by clinicians to assess patient outcome

Type of study: Case-series comparison. Patients: 20 patients (2 males); average age 15.5 years; mean follow-up 22 months. 10 patients (Lenke type 1) had anterior correction and instrumentation; 10 patients (Lenke type 2) had posterior operations. All patients had a selective thoracic fusion (with the type 2 curves having instrumentation incorporating the proximal thoracic curve). Outcome measures: Complications, radiological parameters (Cobb correction of major & compensatory curves); trunk shape (rib hump / scoliometer), and SRS-22 questionnaires. SRS-22 outcomes: There was no significant difference in the pre-operative individual domain scores (pain, self-image, function, mental health, satisfaction) between the two groups. There were no differences in the postoperative results (including self-image) apart from pain. The anterior surgery group had more persistent pain, but at a similar level than preoperatively (3.2 [0.8] vs 4.6 [0.3], p~0.03). Conclusion: For right thoracic (Lenke curve types 1& 2) late-onset idiopathic scoliosis both types of surgery deliver similar radiological and trunk-shape results. SRS-22 self-image and function post-operative results are also similar. The anterior procedure did not however improve the pre-operative pain score

Introduction: The SRS-22 questionnaire is a disease specific instrument developed to assess the effect of idiopathic scoliosis on the patient from their vantage point. This study is being conducted to determine the responsiveness of the SRS-22 questionnaire to patient change associated with surgery. Material and methods: This is a prospective study of surgically treated patients. The SRS-22 outcomes questionnaire consists of five domains: Pain; self image; function; mental health and satisfaction with management/surgery. There are five questions in each of the first four domains and two in the last. The scoring scale is 5 best and 1 lowest. Patients were tested pre-operatively and then at 3, 6 and 12 months post-operatively. Statistical analysis was done using the paired t-test. Comparisons were only performed on individuals with domain scores at the follow-up interval being tested. There were 33 patients (6 male and 27 female) average age 15.7 years with average Cobb size of 64°. Results: Self image was significantly improved at three months and remained improved; Pre-operative 3.3; 3 months 4.2 p< 0.0001); 6 months 4.0 (p=0.079); and 12 months 4.2 (p> 0.0425). Function was significantly decreased at three months but returned to baseline at 6 and 12 months: Pre-operative 3.9; 3 months post-operative 3.3 (p=0.0024); 6 months 3.8 (ns) and 12 months 4.0 (ns). Surprisingly pain did not show significant change being 3.9 pre-operatively; 3.6 at 3 months; 3.5 at 6 months, and 4.1 at 12 months. Conclusion: Based on these very preliminary data the SRS-22 questionnaire has been found to be responsive to self image and function changes in the post-surgical period. The function change was anticipated. The self image improvement occurred earlier than had been anticipated. The questionnaire was not responsive to pain change and did not reflect the substantial pain the patients had gone through at the time of the surgery. As anticipated the mental health domain was unchanged overall

Introduction: It is now well recognised that the patient’s perception of the medical problem and the treatment for the medical problem are not always the same as the facts of the diagnosis and treatment process. The study being reported was conducted to determine the validity of the SRS-22 patient questionnaire for the discrimination of scoliosis patients based on curve pattern and curve size. Materials: Three study groups were developed. The first or control group consisted of patients who had been referred for evaluation of suspected scoliosis but documented by X-ray not to have structural scoliosis of 10° or more. The second group, a non surgical group (NS) consisted of patients with documented idiopathic scoliosis who were either being evaluated and discharged, observed either short or long term, or who had been or would be braced. The third or surgical group (S) were being seen prior to primary idiopathic scoliosis surgery. Patients with comorbidities were excluded. Methods: Deformity pattern and Cobb measurement were determined from standing frontal and sagittal plane radiographs. Each patient completed a SRS-22 outcomes questionnaire leaving off the satisfaction with management domain. Thus there were four domains: pain; self image; function; and mental health, five questions per domain. Scoring is 5 best and 1 lowest. Case series: Patients were gathered between October 1999 and September 2000. The control group consisted of 17 patients average age 13 years. Non surgical group included 72 patients of average age 16 years and average scoliosis of 33°. The surgical group consisted of 33 patients of average age 16 years with an average curve size of 64°. Statistical analysis: The effect of curve pattern was studied with ANOVA and the effect of curve size by the Pearson correlation coefficient. Results: There were 69 patients with single, 33 with double and three with triple curves. There was no difference in SRS domain or total scores based on curve pattern. There was a very significant correlation between curve size and SRS-22 score, p> 0.001 for pain; self image, function; and a total of these domains. For mental health there was also a significant relationship at p=0.0124. Conclusion: The SRS-22 questionnaire successfully discriminates among persons with no scoliosis, moderate scoliosis, and large scoliosis by curve size. It does not discriminate among patients with single, double or triple curves