Purpose. This study aims to identify factors that influence the Cobb angle at presentation to a tertiary referral scoliosis centre, and the outcome of the referrals. Methods. 81 consecutive patients referred were reviewed retrospectively. Hospital database, clinic letters and radiographs were examined. Patient demographics, mode of referral (GP vs. tertiary), severity and type of scoliosis were recorded. The season of referral was defined as ‘warm’ between months of June and September, and ‘cold’ between November and March. Cobb angle measurements were made independently on digital radiographs by 2 Orthopaedic trainees. Results. There were 60 females and 21 males referred. Of these patients, 31 (38%) were offered surgery. The overall mean Cobb angle was 43° (SD 22.5°), where the surgical group was 58° (SD 20°) and the non-surgical group was 33° (SD 18°), p < 0.05. The mean age of the patients for surgery was 22, compared to 19 in the non-operative group (p < 0.05). There was no significant influence of sex, season of referral, and mode of referral on operations offered. Males had a higher mean Cobb angle (52°) than female (39°) with marginal significance (p = 0.09). Advancing age correlated with increasing Cobb angle (r = 0.2, p = 0.09) with marginal significance. No other factors influenced the presenting Cobb angle. There was excellent inter-observer agreement in the Cobb angle measurements (α = 0.99). Conclusion. High Cobb angle and age were the only significant predictors for requirement of surgery in a tertiary referral scoliosis centre. Secondary or tertiary referral did not influence the severity or the outcome of patients with scoliosis. This may imply that GP direct referrals to scoliosis centres are sufficient, especially if Cobb angle measurements and age are included in the criteria. Seasonal differences in scoliosis presentation were not found, however further comparison can be made with countries with warmer climate to demonstrate the cosmetic influence. Ethics Approval: none. Interest Statement: none

Different methods of lateral mass(LM) screw placement in the cervical spine have been described. In the axial plane, 30 degrees is the recommended angle to avoid neurovascular injury. The estimation of this angle remains arbitrary and operator dependant. To assess how accurately the lateral trajectory angle (LTA) for cervical LM screws is achieved by visual estimation amongst experienced spinal surgeons. A sawbone model of cervical spine with simulated lordosis was used. Five spinal consultants and five senior spinal fellows were asked to insert 1.6 mm K wires into lateral masses of C3 to C6 bilaterally to simulate screws. The LTA in transverse plane was measured using a customised protractor. Basic statistical analyses of all the data were obtained. Using all the angles derived, a virtual screw trajectory was drawn in the lateral plane, on a normal axial Computerised Tomography scan of cervical spine of an anonymous patient using PACS system. The overall mean LTA for the group was 25.15 degrees, that of the fellows 24.4 and consultants 26.2 degrees. Mean deviation from 30 degrees for fellows was 5.2 and 6.4 degrees for consultants. Overall standard deviation was 4.78, for fellows and consultants it was 3.3 and 5.8 respectively. Two episodes of vertebral artery injury occurred at 15 and 16 degrees with simulated angles on CT. A moderate variability in visual estimation of the trajectory angle exists even amongst experienced surgeons during insertion of cervical LM screws. An anatomical landmark would be useful to improve the reliability of the procedure

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

Background and Aim. Spinal stability is associated with low back pain and affects the spines ability to support loads. Stability can be achieved if the applied force follows the curvature of the spine, passing close to the vertebral centroids. Previously we showed that calculated muscle forces required for stability in an idealised model increased with increasing and more evenly distributed lumbar curvatures. The purpose of this study was to calculate the muscle forces required for stability in standing in a group of healthy adults. Methods. Positional MRI was used to acquire sagittal images of the lumbar spine in a standing posture in 30 healthy adults. Sacral inclination was measured and active shape modelling used to characterise lumbar spine shape. A two-dimensional model of the lumbar spine was constructed using vertebral centroid positions and a simplified representation of the lumbar extensor muscles. The muscle forces required at each level to produce a follower load were calculated using a force polygon. Results. Sacral angle was positively correlated with the amount of overall curvature in the lumbar spine (P<0.001) but not the distribution of curvature. Muscle forces increased with increasing curvature at all lumbar levels (P<0.02). The distribution of curvature affected the muscle forces only at L3 (P<0.03). Conclusion. In a sample of healthy adults, muscle forces required to maintain stability are determined by the overall curviness of the lumbar spine and, to a lesser extent, the distribution of curvature. Variations in spinal shape should be considered when modelling lumbar spine loading. This abstract has not been previously published in whole or substantial part nor has it been presented previously at a national meeting. Conflicts of interest: No conflicts of interest. Sources of funding: This work was supported by a studentship granted to the University and awarded to AVP. An NHS Endowment grant provided further funding

Our aim in this prospective radiological study was to determine whether the flexibility rate calculated from radiographs obtained during forced traction under general anaesthesia, was better than that of fulcrum-bending radiographs before corrective surgery in predicting the extent of the available correction in patients with idiopathic scoliosis. We evaluated 33 patients with a Cobb angle > 60° on a standing posteroanterior radiograph, who had been treated by posterior correction. Pre-operative standing fulcrum-bending radiographs and those with forced-traction under general anaesthesia were obtained. Post-operative standing radiographs were taken after surgical correction. The mean forced-traction flexibility rate was 55% (. sd. 11.3) which was significantly higher than the mean fulcrum-bending flexibility rate of 32% (. sd. 16.1) (p < 0.001). We found no correlation between either the forced-traction or fulcrum-bending flexibility rates and the correction rate post-operatively (p = 0.24 and p = 0.44, respectively). Radiographs obtained during forced traction under general anaesthesia were better at predicting the flexibility of the curve than fulcrum-bending radiographs in curves with a Cobb angle > 60° in the standing position and may identify those patients for whom supplementary anterior surgery can be avoided

Introduction. There is no consensus among scoliosis surgeons on which surface topography method and parameters may be used as an alternative to serial radiography to monitor scoliosis progression. The aim of this study was to evaluate the inter-correlation among surface rotation (4-D formetric II) with 3-D Quantec scan and 2-D cobb's angle measurements for assessing torso asymmetry in adolescent idiopathic scoliosis (AIS). Materials & Methods. A prospective cohort of consecutive 24 patients with adolescent idiopathic scoliosis was accrued from the departmental scoliosis surface topography database. This group comprised of conservatively treated, Spinecor brace treated and postoperative patients in order to assess the wider utility and validity of 2 different surface topography methods (Formetric II & Quantec Spinal Imaging System). Parameters assessed were Q-angle, Suzuki hump sum, Posterior Trunk Symmetry Index (POTSI), surface rotation (rms), surface rotation (max) and maximum Cobb's angle on concurrently done scoliograms. Results. There were 3 male and 21 female patients (87.5%) at a mean age of 14.1 years (range, 10-20 years). Maximum Cobb's angle ranged from 9 degrees to 80 degrees. There was a significant correlation between Cobb angle (mean-35.1°) and Q-angle (mean-21.8°). Scatter plot and regression analysis showed a linear relationship between surface rotation (mean-9.9 root mean square) and POTSI (mean-42.5) as well as Q-angle. Suzuki hump sum was a less reliable parameter. Conclusions. Formimetric scans showed a linear correlation and reproducibility in patients with AIS receiving conservative treatment for smaller magnitude curves, when compared to Quantec scan. Due to ease of use, colourful and multi-mode representation of spinal deformity, Formetric may have an edge of preference for better clinic consultation to patient/parental appreciation of cosmetic issues and gain following treatment

Introduction:

Shoulder balance after surgery is one main attribute of the cosmetic outcome. It has been difficult to assess on 2D images. The balance results from the interaction of rib cage, shoulder joint and scapular positions, spinal alignment and rotation, muscle size and co-ordination and pain interaction. Attempts have been made to predict shoulder balance from radiograph measurements. There is no consensus on this.

Aims. This study aimed to evaluate rasterstereography of the spine as a diagnostic test for adolescent idiopathic soliosis (AIS), and to compare its results with those obtained using a scoliometer. Methods. Adolescents suspected of AIS and scheduled for radiographs were included. Rasterstereographic scoliosis angle (SA), maximal vertebral surface rotation (ROT), and angle of trunk rotation (ATR) with a scoliometer were evaluated. The area under the curve (AUC) from receiver operating characteristic (ROC) plots were used to describe the discriminative ability of the SA, ROT, and ATR for scoliosis, defined as a Cobb angle > 10°. Test characteristics (sensitivity and specificity) were reported for the best threshold identified using the Youden method. AUC of SA, ATR, and ROT were compared using the bootstrap test for two correlated ROC curves method. Results. Of 212 patients studied, 146 (69%) had an AIS. The AUC was 0.74 for scoliosis angle (threshold 12.5°, sensitivity 75%, specificity 65%), 0.65 for maximal vertebral surface rotation (threshold 7.5°, sensitivity 63%, specificity 64%), and 0.82 for angle of trunk rotation (threshold 5.5°, sensitivity 65%, specificity 80%). The AUC of ROT was significantly lower than that of ATR (p < 0.001) and SA (p < 0.001). The AUCs of ATR and SA were not significantly different (p = 0.115). Conclusion. The rasterstereographic scoliosis angle has better diagnostic characteristics than the angle of trunk rotation evaluated with a scoliometer, with similar AUCs and a higher sensitivity. Cite this article: Bone Joint J 2023;105-B(4):431–438

Aims. Historically, patients undergoing surgery for adolescent idiopathic scoliosis (AIS) have been nursed postoperatively in a critical care (CC) setting because of the challenges posed by prone positioning, extensive exposures, prolonged operating times, significant blood loss, major intraoperative fluid shifts, cardiopulmonary complications, and difficulty in postoperative pain management. The primary aim of this paper was to determine whether a scoring system, which uses Cobb angle, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and number of levels to be fused, is a valid method of predicting the need for postoperative critical care in AIS patients who are to undergo scoliosis correction with posterior spinal fusion (PSF). Methods. We retrospectively reviewed all AIS patients who had undergone PSF between January 2018 and January 2020 in a specialist tertiary spinal referral centre. All patients were assessed preoperatively in an anaesthetic clinic. Postoperative care was defined as ward-based (WB) or critical care (CC), based on the preoperative FEV1, FVC, major curve Cobb angle, and the planned number of instrumented levels. Results. Overall, 105 patients were enrolled. Their mean age was 15.5 years (11 to 25) with a mean weight of 55 kg (35 to 103). The mean Cobb angle was 68° (38° to 122°). Of these, 38 patients were preoperatively scored to receive postoperative CC. However, only 19% of the cohort (20/105) actually needed CC-level support. Based on these figures, and an average paediatric intensive care unit stay of one day before stepdown to ward-based care, the potential cost-saving on the first postoperative night for this cohort was over £20,000. There was no statistically significant difference between the Total Pathway Score (TPS), the numerical representation of the four factors being assessed, and the actual level of care received (p = 0.052) or the American Society of Anesthesiologists grade (p = 0.187). Binary logistic regression analysis of the TPS variables showed that the preoperative Cobb angle was the only variable which significantly predicted the need for critical care. Conclusion. Most patients undergoing posterior fusion surgery for AIS do not need critical care. Of the readily available preoperative measures, the Cobb angle is the only predictor of the need for higher levels of care, and has a threshold value of 74.5°. Cite this article: Bone Joint J 2024;106-B(7):713–719

Aims. This systematic review aims to identify 3D predictors derived from biplanar reconstruction, and to describe current methods for improving curve prediction in patients with mild adolescent idiopathic scoliosis. Methods. A comprehensive search was conducted by three independent investigators on MEDLINE, PubMed, Web of Science, and Cochrane Library. Search terms included “adolescent idiopathic scoliosis”,“3D”, and “progression”. The inclusion and exclusion criteria were carefully defined to include clinical studies. Risk of bias was assessed with the Quality in Prognostic Studies tool (QUIPS) and Appraisal tool for Cross-Sectional Studies (AXIS), and level of evidence for each predictor was rated with the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. In all, 915 publications were identified, with 377 articles subjected to full-text screening; overall, 31 articles were included. Results. Torsion index (TI) and apical vertebral rotation (AVR) were identified as accurate predictors of curve progression in early visits. Initial TI > 3.7° and AVR > 5.8° were predictive of curve progression. Thoracic hypokyphosis was inconsistently observed in progressive curves with weak evidence. While sagittal wedging was observed in mild curves, there is insufficient evidence for its correlation with curve progression. In curves with initial Cobb angle < 25°, Cobb angle was a poor predictor for future curve progression. Prediction accuracy was improved by incorporating serial reconstructions in stepwise layers. However, a lack of post-hoc analysis was identified in studies involving geometrical models. Conclusion. For patients with mild curves, TI and AVR were identified as predictors of curve progression, with TI > 3.7° and AVR > 5.8° found to be important thresholds. Cobb angle acts as a poor predictor in mild curves, and more investigations are required to assess thoracic kyphosis and wedging as predictors. Cumulative reconstruction of radiographs improves prediction accuracy. Comprehensive analysis between progressive and non-progressive curves is recommended to extract meaningful thresholds for clinical prognostication. Cite this article: Bone Jt Open 2024;5(3):243–251

Aims. The aim of this study was to assess the ability of morphological spinal parameters to predict the outcome of bracing in patients with adolescent idiopathic scoliosis (AIS) and to establish a novel supine correction index (SCI) for guiding bracing treatment. Methods. Patients with AIS to be treated by bracing were prospectively recruited between December 2016 and 2018, and were followed until brace removal. In all, 207 patients with a mean age at recruitment of 12.8 years (SD 1.2) were enrolled. Cobb angles, supine flexibility, and the rate of in-brace correction were measured and used to predict curve progression at the end of follow-up. The SCI was defined as the ratio between correction rate and flexibility. Receiver operating characteristic (ROC) curve analysis was carried out to assess the optimal thresholds for flexibility, correction rate, and SCI in predicting a higher risk of progression, defined by a change in Cobb angle of ≥ 5° or the need for surgery. Results. The baseline Cobb angles were similar (p = 0.374) in patients whose curves progressed (32.7° (SD 10.7)) and in those whose curves remained stable (31.4° (SD 6.1)). High supine flexibility (odds ratio (OR) 0.947 (95% CI 0.910 to 0.984); p = 0.006) and correction rate (OR 0.926 (95% CI 0.890 to 0.964); p < 0.001) predicted a lower incidence of progression after adjusting for Cobb angle, Risser sign, curve type, menarche status, distal radius and ulna grading, and brace compliance. ROC curve analysis identified a cut-off of 18.1% for flexibility (sensitivity 0.682, specificity 0.704) and a cut-off of 28.8% for correction rate (sensitivity 0.773, specificity 0.691) in predicting a lower risk of curve progression. A SCI of greater than 1.21 predicted a lower risk of progression (OR 0.4 (95% CI 0.251 to 0.955); sensitivity 0.583, specificity 0.591; p = 0.036). Conclusion. A higher supine flexibility (18.1%) and correction rate (28.8%), and a SCI of greater than 1.21 predicted a lower risk of progression. These novel parameters can be used as a guide to optimize the outcome of bracing. Cite this article: Bone Joint J 2022;104-B(4):495–503

Aims. Scoliosis is a lateral curvature of the spine with associated rotation, often causing distress due to appearance. For some curves, there is good evidence to support the use of a spinal brace, worn for 20 to 24 hours a day to minimize the curve, making it as straight as possible during growth, preventing progression. Compliance can be poor due to appearance and comfort. A night-time brace, worn for eight to 12 hours, can achieve higher levels of curve correction while patients are supine, and could be preferable for patients, but evidence of efficacy is limited. This is the protocol for a randomized controlled trial of ‘full-time bracing’ versus ‘night-time bracing’ in adolescent idiopathic scoliosis (AIS). Methods. UK paediatric spine clinics will recruit 780 participants aged ten to 15 years-old with AIS, Risser stage 0, 1, or 2, and curve size (Cobb angle) 20° to 40° with apex at or below T7. Patients are randomly allocated 1:1, to either full-time or night-time bracing. A qualitative sub-study will explore communication and experiences of families in terms of bracing and research. Patient and Public Involvement & Engagement informed study design and will assist with aspects of trial delivery and dissemination. Discussion. The primary outcome is ‘treatment failure’ (Cobb angle progression to 50° or more before skeletal maturity); skeletal maturity is at Risser stage 4 in females and 5 in males, or ‘treatment success’ (Cobb angle less than 50° at skeletal maturity). The comparison is on a non-inferiority basis (non-inferiority margin 11%). Participants are followed up every six months while in brace, and at one and two years after skeletal maturity. Secondary outcomes include the Scoliosis Research Society 22 questionnaire and measures of quality of life, psychological effects of bracing, adherence, anxiety and depression, sleep, satisfaction, and educational attainment. All data will be collected through the British Spine Registry. Cite this article: Bone Jt Open 2023;4(11):873–880

Aims. To systematically evaluate whether bracing can effectively achieve curve regression in patients with adolescent idiopathic scoliosis (AIS), and to identify any predictors of curve regression after bracing. Methods. Two independent reviewers performed a comprehensive literature search in PubMed, Ovid, Web of Science, Scopus, and Cochrane Library to obtain all published information about the effectiveness of bracing in achieving curve regression in AIS patients. Search terms included “brace treatment” or “bracing,” “idiopathic scoliosis,” and “curve regression” or “curve reduction.” Inclusion criteria were studies recruiting patients with AIS undergoing brace treatment and one of the study outcomes must be curve regression or reduction, defined as > 5° reduction in coronal Cobb angle of a major curve upon bracing completion. Exclusion criteria were studies including non-AIS patients, studies not reporting p-value or confidence interval, animal studies, case reports, case series, and systematic reviews. The GRADE approach to assessing quality of evidence was used to evaluate each publication. Results. After abstract and full-text screening, 205 out of 216 articles were excluded. The 11 included studies all reported occurrence of curve regression among AIS patients who were braced. Regression rate ranged from 16.7% to 100%. We found evidence that bracing is effective in achieving curve regression among compliant AIS patients eligible for bracing, i.e. curves of 25° to 40°. A similar effect was also found in patients with major curve sizes ranging from 40° to 60° when combined with scoliosis-specific exercises. There was also evidence showing that a low apical vertebral body height ratio, in-brace correction, smaller pre-brace Cobb angle, and daily pattern of brace-wear compliance predict curve regression after bracing. Conclusion. Bracing provides a corrective effect on scoliotic curves of AIS patients to achieve curve regression, given there is high compliance rate and the incorporation of exercises. Cite this article: Bone Joint J 2024;106-B(3):286–292

Background. Musculoskeletal disorders, including low back pain, affects 68% of UK physiotherapists across their career with patient handling considered a key risk factor. Manual handling training is mandatory for all allied health professionals, however there is limited research investigating whether professionals adopt recommended manual handling principles following training. Purpose of Study. To investigate spinal angles when facilitating sit-to-stand, and a turning manoeuvre in bed, comparing first-year physiotherapy students (who have not received manual handling training) with final-year physiotherapy students (who have received manual handling training). Methods. Cross-sectional pilot study (n= 20; 10 first-year, 10 final-year). All participants were exposed to a short training video outlining how to safely perform each manoeuvre. Retroreflective markers were attached to: L4, ASIS, PSIS, T12, C7, tragus and canthus. Spinal (neck, thoracic, lumbar and pelvic) angles were established via digital photographs using a bespoke MATLAB programme (MathWorks). A Mann-Whitney U test was conducted to determine between group differences. Results. No statistically significant results were observed between first-year and final-year students for both manoeuvres (p<0.05), except for neck angle during the turning manoeuvre (final-year students demonstrating more upright postures, p=0.037). Interestingly, for the turning manoeuvre in bed it was noted that none of the participants adjusted the bed height. Conclusion. The results suggest that clinical experience and routine manual handling training may not have a significant effect on spinal posture, especially in relation to pelvic, lumbar and thoracic angles. Further work is needed to understand how training relates to adoption of manual handling principles in practice. Conflicts of interest. None. Sources of funding. None

There is a need for non-radiographic, objective outcome measures for children with Adolescent Idiopathic Scoliosis (AIS). Standing balance and stability is altered in children with AIS. The Margin of Stability (MoS) has been used to compare gait stability in clinical populations. Our objective was to compare the MoS in anterior-posterior (MoS. AP. ) and mediolateral (MoS. ML. ) directions in girls with AIS to Controls. Girls with AIS and healthy girls walked at three speeds on an instrumented treadmill wearing retroreflective markers, surrounded by motion capture cameras. The MoS. AP/ML. was calculated at left and right heel strike. Data was processed in Visual 3D. A two-way ANOVA was used to compare MoS. AP/ML. between group, speed and the interaction between group and speed. Pearson's correlation coefficient was used to compare the MoS to Cobb angle. Statistical significance was accepted when p > 0.05. A priori power analysis suggested 12 participants per group. Three Cases and four Controls were recruited. Girls with AIS all had right-sided main thoracic curves (Lenke type 1a, 61.3° ± 10.0°). MoS. AP. was significantly bigger for Cases compared to Controls on the left (p=0.038) and right foot (p=0.041). There was no significant difference between Cases and Controls for MoS. ML. , but there was a visual trend for a smaller MoS. ML. in Cases. There was no significant difference for speed or the interaction between group and speed for MoS. AP. or MoS. ML. In Cases, MoS. AP. increased with increasing Cobb angle on the left (r. 2. =0.687, p=0.054) and right (r. 2. =0.634, p=0.067) and MoS. ML. decreased with increasing Cobb angle on the left (r. 2. =-0.912, p=0.002). Further subjects are being recruited. Girls with Lenke type 1a AIS are more stable in the AP direction and less stable in the ML direction than Controls during treadmill walking. AP stability increases and ML stability decreases with increasing Cobb angle. This research suggests that the MoS could be used as an outcome measure for children with AIS. Continued work is required to increase the power of this study. Further work could consider these changes during walking overground, measuring an MoS or MoS-like measure using a wearable device, and in different curve types

Aims. The optimal procedure for the treatment of ossification of the posterior longitudinal ligament (OPLL) remains controversial. The aim of this study was to compare the outcome of anterior cervical ossified posterior longitudinal ligament en bloc resection (ACOE) with posterior laminectomy and fusion with bone graft and internal fixation (PTLF) for the surgical management of patients with this condition. Methods. Between July 2017 and July 2019, 40 patients with cervical OPLL were equally randomized to undergo surgery with an ACOE or a PTLF. The clinical and radiological results were compared between the two groups. Results. The Japanese Orthopaedic Association (JOA) score and recovery rate in the ACOE group were significantly higher than those in the PTLF group during two years postoperatively, provided that the canal occupying ratio (COR) was > 50%, or the K-line was negative. There was no significant difference in JOA scores and rate of recovery between the two groups in those in whom the COR was < 50%, or the K-line was positive. There was no significant difference in the Cobb angle between C2 and C7, sagittal vertical axis, cervical range of motion (ROM), and complications between the two groups. Conclusion. Compared with PTLF, ACOE is a preferred surgical approach for the surgical management of patients with cervical OPLL in that it offers a better therapeutic outcome when the COR is > 50%, or the K-line is negative, and it also preserves better cervical curvature and sagittal balance. The prognosis of ACOE is similar to that of PTLE when the COR is < 50%, or the K-line is positive. Cite this article: Bone Joint J 2023;105-B(4):412–421

Aims. Vertebral body tethering (VBT) is a non-fusion technique to correct scoliosis. It allows correction of scoliosis through growth modulation (GM) by tethering the convex side to allow concave unrestricted growth similar to the hemiepiphysiodesis concept. The other modality is anterior scoliosis correction (ASC) where the tether is able to perform most of the correction immediately where limited growth is expected. Methods. We conducted a retrospective analysis of clinical and radiological data of 20 patients aged between 9 and 17 years old, (with a 19 female: 1 male ratio) between January 2014 to December 2016 with a mean five-year follow-up (4 to 7). Results. There were ten patients in each group with a total of 23 curves operated on. VBT-GM mean age was 12.5 years (9 to 14) with a mean Risser classification of 0.63 (0 to 2) and VBT-ASC was 14.9 years (13 to 17) with a mean Risser classification of 3.66 (3 to 5). Mean preoperative VBT-GM Cobb was 47.4° (40° to 58°) with a Fulcrum unbend of 17.4 (1° to 41°), compared to VBT-ASC 56.5° (40° to 79°) with 30.6 (2° to 69°)unbend. Postoperative VBT-GM was 20.3° and VBT-ASC Cobb angle was 11.2°. The early postoperative correction rate was 54.3% versus 81% whereas Fulcrum Bending Correction Index (FBCI) was 93.1% vs 146.6%. The last Cobb angle on radiograph at mean five years’ follow-up was 19.4° (VBT-GM) and 16.5° (VBT-ASC). Patients with open triradiate cartilage (TRC) had three over-corrections. Overall, 5% of patients required fusion. This one patient alone had a over-correction, a second-stage tether release, and final conversion to fusion. Conclusion. We show a high success rate (95%) in helping children avoid fusion at five years post-surgery. VBT is a safe technique for correction of scoliosis in the skeletally immature patient. This is the first report at five years that shows two methods of VBT can be employed depending on the skeletal maturity of the patient: GM and ASC. Cite this article: Bone Jt Open 2022;3(2):123–129

Aims. The aim of this study was to determine whether there is an increased prevalence of scoliosis in patients who have suffered from a haematopoietic malignancy in childhood. Methods. Patients with a history of lymphoma or leukaemia with a current age between 12 and 25 years were identified from the regional paediatric oncology database. The medical records and radiological findings were reviewed, and any spinal deformity identified. The treatment of the malignancy and the spinal deformity, if any, was noted. Results. From a cohort of 346 patients, 19 (5.5%) had radiological evidence of scoliosis, defined as a Cobb angle of > 10°. A total of five patients (1.4% of the total cohort) had a Cobb angle of > 40°, all of whom had corrective surgery. No patient with scoliosis had other pathology as a possible cause of the scoliosis and all had been treated with high doses of steroids for leukaemia, either acute or chronic myeloid, or acute lymphoblastic. Conclusion. There is an increased prevalence of idiopathic-like scoliosis and larger curves (Cobb angle of > 40°) associated with childhood leukaemia, which has not been previously reported in the literature. Causative factors may relate to the underlying disease process and/or its treatment. Cite this article: Bone Joint J 2021;103-B(8):1400–1404

We present a large single surgeon case series evaluation of a new growth guidance technique for the treatment of progressive early onset scoliosis (EOS). A traditional Luque trolley construct uses wires to hold growth guidance rods together. We describe a new technique that uses domino end to side connectors in place of the wires with the aim of providing a stronger construct to better limit curve progression, while allowing longitudinal growth. We did a thorough retrospective review of patient records and radiological imaging. Sequential measurements of Cobb angle and length of rods were recorded, as well as any further surgical procedures and associated complications. This enabled us to quantify the ability of a technique to limit curve progression and simultaneously allow growth of the construct. In total, 28 patients with EOS (20 idiopathic, four syndromic, and four neuromuscular) have been treated with this technique, 25 of whom have a minimum follow-up of 2 years and 13 have a minimum follow-up of 5 years. The average correction of the preoperative Cobb angle was 48.9%. At the 2-year follow up, the average loss of this initial correction was 15 degrees, rising to only 20 degrees at a minimum of 5 years (including four patients with a follow-up of 8 years or more). The growth of the constructs was limited. The average growth at 2 years was 3.7 mm, rising to 19 mm at the 5-year follow-up. Patients who underwent surgery with this technique before the age of 8 years seemed to do better. This group had a revision rate of only 18% at an average time of 7 years after the index procedure, and the average growth was 22 mm. However, the group that had index surgery after the age of 8 years had a 64% revision rate at an average of 3.2 years after surgery and an average growth of only 11.6 mm. Overall, in the cases series, there were four hardware failures (14%) and one deep infection (3.5%), and only ten patients (36%) had one extra surgery after the index procedure. Only two of the 13 patients who are at a follow-up of 5 years or more have had revision. This modified Luque trolley technique has a good capacity for initial curve correction and for limiting further curve progression, with limited longitudinal growth before 2 years and improved growth thereafter. This technique might not be so useful after the age of 8 years because of poor growth and a higher early revision rate. We have also demonstrated a low cost technique with a low hardware failure rate that saves many future surgeries for the patient compared with other techniques used in the treatment of EOS

Aims. This study addressed two questions: first, does surgical correction of an idiopathic scoliosis increase the volume of the rib cage, and second, is it possible to evaluate the change in lung function after corrective surgery for adolescent idiopathic scoliosis (AIS) using biplanar radiographs of the ribcage with 3D reconstruction?. Methods. A total of 45 patients with a thoracic AIS which needed surgical correction and fusion were included in a prospective study. All patients underwent pulmonary function testing (PFT) and low-dose biplanar radiographs both preoperatively and one year after surgery. The following measurements were recorded: forced vital capacity (FVC), slow vital capacity (SVC), and total lung capacity (TLC). Rib cage volume (RCV), maximum rib hump, main thoracic curve Cobb angle (MCCA), medial-lateral and anteroposterior diameter, and T4-T12 kyphosis were calculated from 3D reconstructions of the biplanar radiographs. Results. All spinal and thoracic measurements improved significantly after surgery (p < 0.001). RCV increased from 4.9 l (SD 1) preoperatively to 5.3 l (SD 0.9) (p < 0.001) while TLC increased from 4.1 l (SD 0.9) preoperatively to 4.3 l (SD 0.8) (p < 0.001). RCV was correlated with all functional indexes before and after correction of the deformity. Improvement in RCV was weakly correlated with correction of the mean thoracic Cobb angle (p = 0.006). The difference in TLC was significantly correlated with changes in RCV (p = 0.041). It was possible to predict postoperative TLC from the postoperative RCV. Conclusion. 3D rib cage assessment from biplanar radiographs could be a minimally invasive method of estimating pulmonary function before and after spinal fusion in patients with an AIS. The 3D RCV reflects virtual chest capacity and hence pulmonary function in this group of patients. Cite this article: Bone Joint J 2022;104-B(1):112–119