Aims:

Identifying and scoring risk factors that predict early wound dehiscence and progression to metalwork infection. Results of wound healing, eradication of infection and union of with the use of vacuum dressing. Compare results of serial washouts against early vacuum dressing in this group of children with significant medical co-morbidities.

Background: To assess whether modern instrumentation systems are biomechanically strong enough to allow instrumented fusion to pelvis on the concavity of the major curve only and if this confers a significant advantage with respect to complications rates and disadvantages with respect to correction achieved and fusion rates.

Methods: A retrospective review from the notes and radiographs of blood loss, operation time, complication rates, degree of correction and fusion rates. Comparisons drawn with neuromuscular curves of similar aetiology treated by same surgeon using more traditional two rod fusion techniques. Subjects were high risk children with progressive neuromuscular scoliosis of varying aetiology requiring stabilisation. (7 cases to date) We compared operation times, blood loss, complication rates, degree of correction and fusion rates with standard segmental fusion techniques in a similar cohort of children. Basic statistical analysis only required to compare the two groups (Analysis of Variance (ANOV A) and Chi squared tests)

Results: Mean operation times, blood loss and complication rates of this small cohort were lower than the control group. No implant failure to date with longest follow-up now approaching two years.

Conclusion: We hope to open a debate as to whether there is a place for this more limited fusion technique in an effort to minimise the complication rates in these highly challenging children

Background: To quantify the distraction forces required to lengthen a standard subcutaneous domino linked two rod construct. This was a seminal piece of work as part of a project to design a magnetic coil driven micro electromechanical internal device that would mitigate the need for surgical lengthenings of these growth rod constructs.

Methods: A distraction tool with strain gauge was designed and built in the RNOH Department of Biomechanics and following calibration and testing was used to perform five distraction procedures. Subjects were five patients with early onset progressive scoliosis unresponsive to conservative treatment modalities who have previously had a subcutaneous rodding procedure and are hence having regular lengthenings. Forces were transduced and collected on a laptop computer in theatre running a piece of software specifically written for the experiment.

Results: Forces will be displayed in graphical format with correlation with pre- and post-lengthening radiographs.

Conclusion: The magnitude of force required to achieve distraction is compatible with that achievable via a magnetic coil driven internal micro electromechanical device that we are currently in the design phase of producing.

Background: To stimulate a debate as to whether neurological compromise as a result of spinal instrumentation is the result of direct or indirect cord injury of more the result of cord ischaemia due to the highly abnormal vascular anatomy encountered in these patients.

Methods: Review of three cases of neuromuscular scoliosis who underwent angiograms under general anaesthetic. Graphical comparisons with normal patterns spinal vascular anatomy

Results: Vascular anatomy was found to be so abnormal in these patients that the series was discontinued due to the perceived risk of paraplegia as a result of the angiogram procedure itself.

Conclusion: We plan to perform CT angiograms in patients with neuromuscular scoliosis to further elucidate the vascular anatomy in these patients

Background: To assess the use of subcutaneous rodding with sequential lengthening procedures to control progressive early onset curves not responding to conservative treatment modalities.

Methods: A retrospective study reviewing the notes and plain radiographs of all children with early onset scoliosis treated by growth rod insertion over a seven year period (two paediatric spinal surgeons using similar techniques at two major centres). Subjects were children with early onset scoliosis unresponsive to conservative management. Outcome measures – curves at time of instrumentation, curve progression, number of lengthenings, curve magnitude and age at time of definitive fusion, spinal growth achieved and complications encountered.

Results: Majority of children treated uneventfully with satisfactory control of curvature until age at which definitive fusion acceptable. However our results do suggest a number of cases and circumstances where simple growth rod instrumentation is not sufficient and augmentation with anterior apical fusion is required (will discuss these on an individual basis).

Conclusion: The management of early onset progressive scoliosis by means of growth rod instrumentation and sequential lengthenings is safe and effective.