Background and purpose. The musculoskeletal system is recognized as a possible source of pain in patients with chest pain. The objectives of the present study were (1) to investigate the interobserver reliability of an overall diagnosis of musculoskeletal chest pain using a standardized examination protocol in a cohort of patients with chest pain suspected to be of non-cardiac origin, (2) to investigate the interobserver reliability of the single components of the protocol, and finally, (3) to investigate the importance of clinical experience on the level of interobserver reliability. Methods and results. Eighty patients with acute chest pain were recruited from a cardiology department. Four observers (two chiropractors and two chiropractic students) performed a physical examination and an extended manual examination of the spine and chest wall. Percentage agreement, Cohen's Kappa and ICC were calculated for observer pairs and overall. Musculoskeletal chest pain was diagnosed in 44.0 % of patients. Interobserver kappa values were substantial for the chiropractors and overall, and moderate for the students. For single items of the protocol, both pairs showed fair to substantial agreement regarding pain provocation tests and poor to fair agreement regarding spinal segmental dysfunction tests. Conclusions. Suspected musculoskeletal chest pain can be identified with substantial interobserver reliability using this standardized protocol if used by experienced and trained observers. Agreement for individual components of the protocol showed, however, considerable variation. Provided training of observers, the examination protocol can be used in selected patients and can be implemented in pre- and post-graduate clinical training

Introduction. Spinopelvic parameters describe the orientation, shape, and morphology of the spine and pelvis. These parameters change during the first 10 years of life in children without spinal deformity; however, spinopelvic parameters have yet to be defined in children with significant early-onset scoliosis (EOS). Sagittal plane alignment could affect the natural history and outcome of interventions for EOS. As a result, spinopelvic parameters are being defined for this population. On the basis of the landmarks used for measurement of these parameters, there may be inherent error in performing these measurements on the immature pelvis. The purpose of this study is to define the variability associatedwith the measurement of spinopelvic parameters in children with EOS. Methods. Standing, lateral radiographs of 11 patients with untreated EOS were evaluated. Sagittal spinopelvic parameters (pelvic incidence [PI], pelvic tilt [PT], sacral slope [SS], and modified pelvic radius angle [PR]) were measured. To assess intraobserver reliability, these measurements were repeated 15 days apart. To define interobserver reliability, radiographs were measured by 2 independent observers. Results. Average age was 5·7 years and average Cobb angle was 80·8°. Repeated measurements by one observer showed no significant differences for any of the parameters. Paired samples correlations showed a moderate correlation between measurements of PI (0·564), whereas stronger correlations were demonstrated for measurements of PT (0·816), SS (0·947), and PR (0·789). Interobserver analysis showed a significant difference in measurement of SS (p=0·003), whereasmeasurements of PI, PT, and PR did not differ significantly between independent observers. Conclusions. Intraobserver variabilty yielded acceptable correlations for PT, SS, and PR; however, we noted only a moderate correlation for PI. Interobserver analysis showed a significant difference only in SS. The intraobserver and interobserver variablity of measurements for PT and PR were superior than were those for PI and SS. This finding may be related to difficulties in determining the orientation of the sacral endplate in the immature pelvis when measuring PI and SS

Purpose of the study. We propose a simple classification for adolescent idiopathic scoliosis (AIS) based on two components which include the curve type and shoulder level and suggest a treatment algorithm for AIS. Introduction. Few Classification systems for adolescent idiopathic scoliosis (AIS) have helped in communicating, understanding and selecting a treatment for this condition; however, most of these classifications are complex and include many subtypes, making it difficult for the orthopaedic surgeon to use them in clinical practice. The variable reliability and reproducibility of these studies make recommendations and comparisons between various operative treatments a difficult task. Furthermore, none of these classifications has taken the shoulder imbalance into account, despite its importance as a clinical parameter and outcome measure. Methods. We developed a classification system with two components: curve type (I through III) and shoulder level (A or B). The curve types are divided into type I: Primary lumbar-thoracolumbar +/− secondary dorsal; type II: Primary dorsal secondary lumbar and type III: Dorsal. Each curve pattern is subdivided into type A or B depending on the shoulder level. In type A, the lower shoulder is ipsilateral to the concavity of the primary curve. In type B, the shoulders are level or the lower shoulder is on the convexity of the primary curve. This classification was tested for interobserver reliability and intraobserver reproducibility by six surgeons using radiographs of 28 patients. We performed a retrospective analysis of the radiographs of 232 consecutive AIS cases to assess the prevalence of curve types and tested the surgical treatment against the proposed treatment algorithm. Results. Three major types and six subtypes were identified, of which type I accounted for 30%, type II 28% and type III 42%. The kappa coefficient for interobserver reliability was 0.943, while the kappa value for intraobserver reproducibility was 0.964. There was a complete concordance with the shoulder level component. Of the 232 cases reviewed, with a minimum two-year follow-up, only three patients developed a decompensation distal to the instrumentation requiring fusion extension. Conclusion. This classification is the first of its kind to specifically address shoulder imbalance in the surgical decision-making process. The high interobserver reliability and intraobserver reproducibility is due in part to the simplicity of this classification, which makes it an invaluable tool to describe scoliosis curves and offers a potential treatment algorithm in correcting scoliosis

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.

Study design. Retrospective study. Objectives. To optimise the radiation doses and image quality for the cone-beam O-arm surgical imaging system in spinal surgery. Summary of Background. Neurovascular compromise has been reported following screw misplacement during thoracic pedicle screw insertion. The use of O-arm with or without navigation system during spinal surgery has been shown to lower the rate of screw misplacement. The main drawback of such imaging surgical systems is the high radiation exposure. Methods. Chest phantom and cadaveric pig spine were examined on the O-arm with different scan settings: two were recommended by the O-arm manufacturer (120 kV/320 mAs, and 120 kV/128 mAs), and three low-dose settings (80 kV/80 mAs, 80 kV/40 mAs, and 60 kV/40 mAs). The radiation doses were estimated by Monte Carlo calculations. Objective evaluation of image quality included interobserver agreement in the measurement of pedicular width in chest phantom and assessment of screw placement in cadaveric pig spine. Results. The effective dose/cm for 120 kV/320 mAs-scan was 13, 26, and 69 times higher than those delivered with 80 kV/80 mAs, 80 kV/40 mAs, and 60 kV/40 mAs-scans, respectively. Images with 60 kV/40 mAs were unreliable. Images with 80 kV/80 mAs were considered reliable with good interobserver agreement when measuring the pedicular width (random error 0.38 mm and intraclass correlation coefficient 0.979) and almost perfect agreement when evaluating the screw placement (κ-value 0.86). Conclusions. The radiation doses of the O-arm system can be reduced 5–13 times without negative impact on image quality with regard to information required for spinal surgery

Aims

The aim of this study was to investigate the incidence and characteristics of instrumentation failure (IF) after total en bloc spondylectomy (TES), and to analyze risk factors for IF.

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To identify the incidence and risk factors for five-year same-site recurrent disc herniation (sRDH) after primary single-level lumbar discectomy. Secondary outcome was the incidence and risk factors for five-year sRDH reoperation.

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The aims of this study were first, to determine if adding fusion to a decompression of the lumbar spine for spinal stenosis decreases the rate of radiological restenosis and/or proximal adjacent level stenosis two years after surgery, and second, to evaluate the change in vertebral slip two years after surgery with and without fusion.

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Although lumbosacral transitional vertebrae (LSTV) are well-documented, few large-scale studies have investigated thoracolumbar transitional vertebrae (TLTV) and spinal numerical variants. This study sought to establish the prevalence of numerical variants and to evaluate their relationship with clinical problems.

Aims

The aim of this study was to determine the differences in spinal imaging characteristics between subjects with or without lumbar developmental spinal stenosis (DSS) in a population-based cohort.

Purpose of the study. The aim of this work was to study the influence of the slice orientation of T2 axial images in numerical measurements of DSCA and study the effect that this change of slice angle would have on the morphological grading assessment. Methods and Results. TSE T2 three dimensional aquisition MRI studies reconstructed with OsiriX DICOM viewer from 32 patients were used. Patients included were a series of consecutive cases with either suspected spinal stenosis or low back pain. A total of 97 disc levels were studied and axial reconstructions were made at 0°, +10°, +20°, +30° relative to the disc space orientation. For each image, DSCA was digitally measured and a severity grade was assigned by two observers according to the recently-published 4-point (A-D) morphological grading system. Interobserver kappa score was 0.71. Statistical analysis of DSCA measurements was performed using kappa and t-tests. Comparing DCSA between 0° at each level and +10°, +20° and +30° slice orientation, a significant increase in surface area was found in each case (P<0.0001). % change in DSCA combining all disc levels comparing 0° and +10°: range -15.48% to +31.89% (SD 18.40%); 0° and +20°: range -24.00% to +143.82% (SD 20.45%); 0° and +30°: range -29.35% to +231.13% (SD 26.52%). At 13 disc levels, DSCA was <100mm. 2. at 0°, but changed to >100mm. 2. in three cases by a +10° increase, in five cases by a +20° increase and in 10 cases by a +30° increase. In only two out of 97 levels studied did the morphological grading change as the angle increased, one of which was not amongst those above (change in DSCA from <100mm. 2. to >100mm. 2. ). Conclusion. MRI slice angle significantly affects DSCA, and thus potentially the decision taken regarding management whilst morphological grading is little affected by image acquisition technique

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To study the associations of lumbar developmental spinal stenosis (DSS) with low back pain (LBP), radicular leg pain, and disability.

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To report the outcome of spinal deformity correction through anterior spinal fusion in wheelchair-bound patients with myelomeningocele.

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The aim of this study was to determine the influence of developmental spinal stenosis (DSS) on the risk of re-operation at an adjacent level.

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The aim of this study was to explore risk factors for complications associated with dural tear (DT), including the types of DT, and the intra- and postoperative management of DT.

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There is little information about the optimum number of implants to be used in the surgical treatment of idiopathic scoliosis. Retrospective analysis of prospectively collected data from the Swedish spine register was undertaken to discover whether more implants per operated vertebra (implant density) leads to a better outcome in the treatment of idiopathic scoliosis. The hypothesis was that implant density is not associated with patient-reported outcomes, the correction of the curve or the rate of reoperation.

Objectives

The objective of this study was to assess the association between whole body sagittal balance and risk of falls in elderly patients who have sought treatment for back pain. Balanced spinal sagittal alignment is known to be important for the prevention of falls. However, spinal sagittal imbalance can be markedly compensated by the lower extremities, and whole body sagittal balance including the lower extremities should be assessed to evaluate actual imbalances related to falls.

Aims

Although we often encounter patients with an aortic aneurysm who also have diffuse idiopathic skeletal hyperostosis (DISH), there are no reports to date of an association between these two conditions and the pathogenesis of DISH remains unknown. This study therefore evaluated the prevalence of DISH in patients with a thoracic aortic aneurysm (AA).

Aims

The primary aim of this study was to evaluate the performance and safety of magnetically controlled growth rods in the treatment of early onset scoliosis. Secondary aims were to evaluate the clinical outcome, the rate of further surgery, the rate of complications, and the durability of correction.

This study evaluates factors related to myelopathic symptoms in patients with ossification of the posterior longitudinal ligament (OPLL). A total of 87 patients with OPLL were included. Of these, 53 (Group I) had no symptoms or presented with neck pain and radiculopathy and 34 (Group II) had myelopathic symptoms. Gender, age, and history of trauma were evaluated in the two groups. The range of movement of the cervical spine was measured using plain radiographs. The number of involved segments, type of OPLL, and maximal compression ratio were analysed using CT and signal change in the spinal cord was evaluated using MRI.

The patients’ age was found to be significant (p = 0.001). No difference was found between gender and the range of movement in the two groups. The maximum compression of the spinal canal showed a difference (p = 0.03). The signal change of the spinal cord was different between the two groups. In patients with OPLL of the cervical spine, myelopathic symptoms are not related to the range of movement or the number of involved segments.