Aims

Psychoeducative prehabilitation to optimize surgical outcomes is relatively novel in spinal fusion surgery and, like most rehabilitation treatments, they are rarely well specified. Spinal fusion patients experience anxieties perioperatively about pain and immobility, which might prolong hospital length of stay (LOS). The aim of this prospective cohort study was to determine if a Preoperative Spinal Education (POSE) programme, specified using the Rehabilitation Treatment Specification System (RTSS) and designed to normalize expectations and reduce anxieties, was safe and reduced LOS.

We present the 2 year results for the first 54 patients after Selective Dorsal Rhizotomy (SDR) delivered in Bristol, concentrating on change in Reimers' migration index.

Eligible patients are selected at the SDR multidisciplinary meeting. Physiotherapy assessment is performed pre-operatively and at 6, 12 and 24 months post-surgery. Data collected includes GMFCS, Gross Motor Function Measure (GMFM) 88 and Modified Ashworth score for spasticity for major lower limb muscle groups, amongst other data. Pelvic radiographs are taken pre-operatively and at 2 years post-operatively. Reimers' migration index was measured using the hospital picture archiving and communication system (PACS).

The mean age was 7.2 (3.9–17.5) at the time of surgery. Pre- and post-operative pelvic radiographs were available for 30 patients (60 hips). 57% (n=34) hips showed an increase in migration percentage (mean 5.4%, range 0.1–17.5%) and 43% (n=26) hips showed a decrease (mean 4.0%, range 0–15.5%). Overall no significant difference was found in Reimers' migration index at 2 year follow up (mean increase 1.3% (95% CI −0.3–3.0), p=0.12).

There was an improvement in GMFCS category (by 1 grade) for 9 patients and a worsening for 1 patient at 2 year follow up. The Modified Ashworth score for spasticity improved in all patients. There was a mean improvement of 1.7 in the hip adductors and 2.4 in the ankle plantar flexors.

There was a statistically significant improvement in the GMFM 88 D and E domains of 14.7 (95% CI 11.3–18.1), p<0.0001 and 11.4 (95% CI 7.4–15.7), p<0.0001 respectively.

We found no evidence that SDR leads to worsening hip subluxation at 2 year follow up. All patients had improvement in lower limb spasticity. Overall there was a statistically significant improvement in function, as shown by GMFM 88 domains for standing, walking, running and jumping.

Assessing the efficacy of cervical orthoses in restricting spinal motion has historically proved challenging due to a poor understanding of spinal kinematics and the difficulty in accurately measuring spinal motion. This study is the first to use an 8 camera optoelectronic, passive marker, motion analysis system with a novel marker protocol to compare the effectiveness of the Aspen, Aspen Vista, Philadelphia, Miami-J and Miami-J Advanced collars. Restriction of cervical spine motion was assessed for physiological and functional range of motion (ROM).

Nineteen healthy volunteers (12 female, 7 male) were fitted with collars by an approved physiotherapist. ProReflex (Qualisys, Sweden) infra-red cameras were used to track the movement of retro-reflective marker clusters attached to the head and trunk. 3-D kinematic data was collected from uncollared and collared subjects during forward flexion, extension, lateral bending and axial rotation for physiological ROM and during five activities of daily living (ADLs). ROM in the three clinical planes was analysed using the Qualisys Track Manager (Qualisys, Sweden) 6 Degree of Freedom calculation to determine head orientation relative to the trunk.

For physiological ROM, the Aspen and Philadelphia were more effective at restricting flexion/extension than the Vista (p<0.001), Miami-J (p<0.001 and p<0.01) and Miami-J Advanced (p<0.01 and p<0.05). The Aspen was more effective at restricting rotation compared to the Vista (p<0.001) and Miami-J (p<0.05). The Vista was least effective at restricting lateral bending (p<0.001). Through functional ROM, the Vista was less effective than the Aspen (p<0.001) and other collars (p<0.01) at restricting flexion/extension. The Aspen and Miami-J Advanced were more effective at restricting rotation than the Vista (p<0.01 and p<0.05) and Miami-J (p<0.05). All the collars were comparable when restricting lateral bending.

The Aspen is superior to, and the Aspen Vista inferior to, the other collars at restricting cervical spine motion through physiological ROM. Functional ROM observed during ADLs are less than those observed through physiological ROM. The Aspen Vista is inferior to the other collars at restricting motion through functional ROM. The Aspen collar again performs well, particularly at restricting rotation, but is otherwise comparable to the other collars at restricting motion through functional ranges.

Objective

To compare the effectiveness of the Aspen, Aspen Vista, Philadelphia, Miami-J and Miami-J Advanced collars at restricting cervical spine movement in the sagittal, coronal and axial planes.