Study Aims: This study’s objectives were to measure pre-operative and postoperative axial vertebral rotational deformity at the curve apex in endoscopically-treated anterior-instrumented scoliosis patients using CT, and assess the relevance of these findings to clinically measured chest wall rib hump deformity correction.

Introduction: Thoracoscopic instrumented anterior spinal fusion for adolescent idiopathic scoliosis (AIS) has clinical benefits that include reduced pulmonary morbidity, postoperative pain, and improved cosmesis. However, quantitative data on radiological improvement of vertebral rotation using this method is lacking.

Methods: Between November 2002 and August 2005, 20 AIS patients with right-sided thoracic major curves underwent endoscopic single-rod anterior fusion. Preoperative and two-year postoperative CT was performed to assess axial vertebral rotation at the curve apex. Correlation between apical vertebral rotation measured on CT and rib hump measured using a scoliometer was assessed.

Results: The mean angle of correction achieved in axial vertebral body derotation at the apical vertebra measured by CT was 7.9° and equated to 43% improvement. Preoperative and postoperative rib hump deformity correction correlated significantly with CT measurements using regression analysis (p=0.03). The mean improvement in rib hump deformity was 55%. Conclusion: We believe this is the first quantitative CT study to confirm that endoscopic anterior instrumented fusion for AIS substantially improves axial vertebral body rotational deformity at the apex of the curve. The margin of correction of 43% compares favourably with historically published figures of 24% for patients with posterior all-hook-rod constructs. CT measurements correlated significantly to the clinical outcome of rib hump deformity correction.

Ethics: local committee approval

Statement of Interest: none

The aim of this study was to determine the prevalence of deep venous thrombosis (DVT) following lower limb arthroplasty and to assess whether this adversely affected satisfaction, relief from pain, or the level of mobility as perceived by patients. Six hundred and ten consecutive recipients of primary total hip replacement (THR) or total knee replacement (TKR) underwent routine post-operative venography. The functional outcome had already been assessed at one year by using the Regional Arthroplasty Database questionnaire, the results of which were correlated to venographic records.

The combined prevalence of DVT after THR and TKR in the patients, who did not receive chemical thromboprophylaxis, was 46.4%. Thrombus was identified in 57.6% of those with a TKR and in 33.5% of patients with a THR. Proximal thrombus was found in 11.0% of TKRs and in 14.8% of THRs. One year after surgery, patients who had a DVT established by venography did not report higher levels of immobility (p = 0.07), discomfort (p = 0.12) or dissatisfaction (p = 0.23) when compared to those with patent venous systems.

This suggests that the prevalence of DVT following TKR/THR without chemical thromboprophylaxis is high and these findings are consistent with the literature. However, patients did not perceive thrombosis to compromise their overall outcome. This challenges the belief that DVT is associated with morbidity and calls for further comprehensive research in this area. The low morbidity of the lower limb associated with DVT in these patients does not support the use of chemical thromboprophylaxis.

Deep venous thrombosis (DVT) and clinical outcome measurements in a series of 610 patients who did not receive routine chemical thromboprophylaxis for lower limb arthroplasty were studied. Patients who had undergone primary total hip or knee replacement under the care of two orthopaedic consultants were identified from the Trent Arthroplasty Database. Surgery was performed between 1992 and 1999 in one hospital only. Venography was undertaken on the seventh to tenth postoperative day. Patients with proximal thrombosis were anti-coagulated with warfarin as per protocol. Venogram reports were available for 81% of cases.

One year following surgery a standard postal questionnaire was sent to all patients. A response rate of 88% was achieved. Data was captured with respect to residual pain, ability to walk and the overall satisfaction with joint replacement.

DVT following total hip (THR) or knee replacement (TKR) in patients who did not receive routine chemical thromboprophylaxis was common (46. 4%) in line with other studies.

Knee surgery was associated with a high prevalence of thrombosis (57. 6%) compared to hip replacement although only one fifth of DVTs were found to extend into a proximal vein. Approximately half (44. 2%) of all THR associated thrombus was above knee DVT. Questionnaire responses evaluating clinical outcome and satisfaction were correlated to venographic results and analysed using an SPSS statistical package. Using Chi-squared analysis no statistically significant differences were found between deep venous thrombosis and patient-perceived pain (p=0. 12), mobility (p=0. 07) or overall satisfaction (p=0. 23). It is generally assumed that chemical thromboprophylaxis will diminish DVT related complications such as post-phlebitic limb syndrome. Despite a high prevalence of thrombosis in patients who did not receive pharmacological agents for prophylaxis, this study did not demonstrate an adverse outcome on pain, function or patient satisfaction. Morbidity as a result of DVT needs to be studied further before the role of chemical thromboprophylaxis can be determined.

We present a study of ten consecutive patients who underwent excision of thoracic or thoracolumbar hemivertebrae for either angular deformity in the coronal plane, or both coronal and sagittal deformity. Vertebral excision was carried out anteriorly alone in two patients. Seven patients had undergone previous posterior spinal fusion. Their mean age at surgery was 13.4 years (6 to 19). The mean follow-up was 78.5 months (20 to 180). The results were evaluated by radiological review of the preoperative, postoperative and most recent follow-up films.

The mean preoperative coronal curve was 78.2° (30 to 115) and was corrected to 33.9° (7 to 58) postoperatively, a mean correction of 59%. Preoperative coronal decompensation of 35 mm was improved to 11 mm postoperatively. Seven patients had significant coronal decompensation preoperatively, which was corrected to a physiological range postoperatively. There were no major complications and no neurological damage.

We have shown that resection of thoracic and thoracolumbar hemivertebrae can be performed safely, without undue risk of neurological compromise, in experienced hands.