It is not known how parents of children with scoliosis perceive cosmetic issues in their offspring. There is little clinical information regarding parental 'surrogate' assessment of a young persons' fears and beliefs regarding how a deformity affects the child and how that might influence the process of informed consent and surgical risk assessment.

There remains debate regarding which surgical approach gives the best outcome, anterior alone or posterior alone, in surgically relevant adolescent idiopathic scoliosis. The operation is mainly cosmetic in terms of health care advantage. This prospective study evaluated scar site preference and other relevant body image parameters prior to any intervention.

Patients and their parents had a structured interview involving SRS20 and Walter Reed Visual Assessment Scale as well as grading of nine AP and lateral clinical photographs specifically of anterior and posterior scoliosis surgery scars. Each clinical image was graded 1-10 on a scale of unsatisfactory and satisfactory. Parents completed assessments as well as the patients.

Results: 28 patients, 6 males, 22 females, 8 females were pre-menarche, mean age 14 (12-17), mean cobb angle 57, completed the study. Mean parental age 45.

There was no significant difference between mean scores for the four anterior scar (6.36) and the five posterior scar (6.35) images. p value 0.49. In parents the preferences were more apparent posterior 6.9, anterior 6.2 but this was not statistically significant (p=0.06)

There was no significant difference between all four domains of the SRS between parent and child. In terms of expressed preference the child had no preference in 7, thoracotomy in 7 and posterior midline in 14, whereas parents expressed no preference in 12, thoracotomy in 4 and posterior midline in 12.

In this prospective study there was no perceived difference in acceptability of anterior or posterior scars for scoliosis surgery approaches.

Purpose of study: Self reported walking distance is a clinically relevant measure of function. Our aim was to report patient accuracy and understand factors that might influence perceived walking distance.

Method: A prospective cohort study. 103 patients were asked to perform one test of distance estimation and 2 tests of functional distance perception using pre-measured landmarks. Standard spine specific outcomes included the patient reported claudication distance, Oswestry disability index (ODI), Low Back Outcome Score (LBOS), visual analogue score (VAS) for leg and back, and Modified Zung Depression index (MZD).

Results: There are over-estimators and under-estimators. Overall the accuracy to within 10 yards was only 5% for distance estimation and 40% for the two tests of functional distance perception. Distance: Actual distance 121.4 yds; mean response 268yds (95% CI 192.8–344.15), Functional test 1 actual distance 32 yards; mean response 78.4 yds (95% CI 58.6–97.3), Functional test 2 actual distance 21.4yds; mean response 51.9yds (95% CI 38.3–65.5). Surprisingly patients over 60 years of age (n=43) are twice as accurate with each test performed compared to those under 60 (n=60) (average 70% overestimation compared to 140%; p=0.06). Patients in social class I (n=18) were more accurate than those in classes II–V (n= 85) (59% vs 131% p=0.13). There was a positive correlation between poor accuracy and increasing MZD (Pearson’s correlation coefficient 0.250; p=0.012). ODI, LBOS and other parameters measured showed no correlation.

Conclusions: Subjective distance perception and estimation is poor in this population. Patients over 60 and those with a professional background are more accurate.

Purpose: Self reported walking distance is a clinically relevant measure of function, our aim was to report patient accuracy and understand factors that might influence perceived walking distance.

Method: A prospective cohort study. 103 patients were asked to perform one test of distance estimation and 2 tests of functional distance perception using pre-measured landmarks. Standard spine specific outcomes included the patient reported claudication distance, Oswestry disability index (ODI), Low Back Outcome Score (LBOS), visual analogue score (VAS) for leg and back, and other measures.

Results: There are over-estimators and under-estimators. Overall the accuracy to within 10 yards was only 5% for distance estimation and 40% for the two tests of functional distance perception. Distance: Actual distance 121.4 yds; mean response 268yds (95% CI 192.8–344.15), Functional test 1 actual distance 32 yards; mean response 78.4 yds (95% CI 58.6–97.3) Functional test 2 actual distance 21.4yds; mean response 51.9yds (95% CI 38.3–65.5). Surprisingly patients over 60 years of age (n=43) are twice as accurate with each test performed compared to those under 60 (n=60) (average 70% overestimation compared to 140%; p=0.06). Patients in social class I (n=18) were more accurate than those in classes II–V (n= 85): There was a positive correlation between poor accuracy and increasing MZD (Pearson’s correlation coefficient 0.250; p=0.012). ODI, LBOS and other parameters measured showed no correlation.

Conclusions: Subjective distance perception and estimation is poor in this population. Patients over 60 and those with a professional background are more accurate.

Ethics approval: not required

Interest Statement: none

Background and Objective: The influence of back pain on work status is normally implied from the severity of the functional limitations. The aim of this cross sectional study was to analyse whether functional assessment instruments correlate well with impact on work status.

Patients and Methods: 375 chronic low back pain patients attending back pain outpatient clinics of a University Hospital and a specialist rehabilitation centre over a period of one year were assessed. The three functional outcome scores measured were Oswestry Disability Index (ODI), Roland Morris disability questionnaire (RMQ) and Orebro Musculoskeletal Pain Questionnaire (OMPQ). The effect of back pain on patient’s work status was recorded in 6 options – work not affected, slightly affected, seriously affected, reduced number of hours, change job or give up job. The work status score was then correlated to the above three instrument values.

Results: There was good correlation among the three instrument values (rho > 0.70) suggesting they are interchangeable. However, there was only a modest correlation between the work status scale and the three functional scores; the rho values were 0.47 for OMPQ, 0.43 for ODI and 0.39 for RMQ. There was no influence of age, duration of pain or type of work on this correlation.

Conclusion: Back pain instruments (which measure pain and functional limitations) and work status are not interchangeable. The impact on work status cannot be implied from these functional scores and should be recorded as a separate outcome measure.

Purpose: To establish the results of a three week functional restoration program in terms of commonly used surgical outcome measures

Method: 135 patients ( 57 male 78 female) undertook a three week functional restoration program consisting of hydrotherapy, gymnasium work, education and cognitive behavioral therapy. They completed pre-program standard questionnaires including the Oswestry Disability Index and the Roland Morris. Follow up was at an average of 26 months (std dev 7) The patient global assessment of worse, unchanged, better and much better were completed as well as the pre-program outcome measures.

Results: Oswestry; Roland Morris

Pre program 34 average: s.d. 158.8; s.d. 4.5

Post program 19 average: s.d. 174.3; s.d. 4.8

Patient Global assessment:

Much better 64; 47%

Excellent 62; 49.6%

Better: 52; 38%

Good: 43; 34.4%

Unchanged: 2; 9%

Fair: 16 ; 2.8%

Worse: 7; 5%

Poor: 4; 3.2%

Data on the impact upon work was available for 121 of the patients. Pre program 71 of the 121 had been seriously affected in the workplace. Work follow up was 79% and at follow up only 22 out of 96 were seriously affected in the workplace. A significant improvement.

43 had an injury at work, RTA or similar significant event, 89 did not. The ODI improved by 18 points in the attributable event group and 13 in the non event group. Similar results were found for the Roland score. There was no significant difference between the two groups.

Conclusion: A very favourable results in the treatment of chronic back pain can be achieved, despite including adverse patient groups. Over 80% of patients were in the ‘success’ treatment groups at follow up using the Scandinavian Spine stabilization study group global assessment tool. Surgeons, patients and health care purchasers need to be aware of what can occur with non surgical treatment.

We have reviewed 80 children who were involved in the Medical Research Council (UK) trial of surgical treatment for tuberculosis of the spine in Hong Kong. Radical surgery or debridement had been performed at mean ages of 7.6 years (n = 47) and 5.1 years (n = 33) respectively. The patients were followed up to skeletal maturity (mean 17 years). Spinal deformity was measured on lateral radiographs taken preoperatively, at six months, one year, five years and at final follow-up. Radical surgery and grafting produced a reduction in kyphos and deformity angles at six months; this correction was maintained during the growth period. By contrast, after debridement surgery there was an increase in deformity at six months, with a tendency to some spontaneous correction during the growth period. There were statistically significant differences between angles for the radical and debridement groups only at six months postoperatively, but the changes during later follow-up were similar in the radical and debridement groups. Our findings highlight the importance of the surgical correction of deformity, and provide no evidence to suggest that disproportionate posterior spinal growth contributes to progression of deformity after anterior spinal fusion in children.