The purpose of this study was to evaluate the long-term outcome of adults with spina bifida cystica (SBC) who had been treated either operatively or non-operatively for scoliosis during childhood.

We reviewed 45 patients with a SBC scoliosis (Cobb angle ≥ 50º) who had been treated at one of two children’s hospitals between 1991 and 2007. Of these, 34 (75.6%) had been treated operatively and 11 (24.4%) non-operatively. After a mean follow-up of 14.1 years (standard deviation (sd) 4.3) clinical, radiological and health-related quality of life (HRQOL) outcomes were evaluated using the Spina Bifida Spine Questionnaire (SBSQ) and the 36-Item Short Form Health Survey (SF-36).

Although patients in the two groups were demographically similar, those who had undergone surgery had a larger mean Cobb angle (88.0º (sd 20.5; 50.0 to 122.0); versus 65.7º (sd 22.0; 51.0 to 115.0); p < 0.01) and a larger mean clavicle–rib intersection difference (12.3 mm; (sd 8.5; 1 to 37); versus 4.1 mm, (sd 5.9; 0 to 16); p = 0.01) than those treated non-operatively. Both groups were statistically similar at follow-up with respect to walking capacity, neurological motor level, sitting balance and health-related quality of life (HRQOL) outcomes.

Spinal fusion in SBC scoliosis corrects coronal deformity and stops progression of the curve but has no clear effect on HRQOL.

Cite this article: Bone Joint J 2014; 96-B:1244–51

Purpose of study

NICE recommends 8-9 sessions of non operative therapy for back pain that has lasted for 6 weeks but less than 12 months. NICE recommended exercises, manual therapy, acupuncture and suggested that Lumbar supports, TENS, Ultrasound and Traction should not be offered. Since multiple methods and disciplines were available a survey was conducted among the local General Practitioners to determine what non operative methods they preferred and how it matched with NICE's recommendation.

Introduction. Patients with metastatic spinal cord compression (MSCC) or unstable spinal lesions warrant early surgical consultation. In multiple myeloma, chemotherapy and radiotherapy have the potential to decompress the spinal canal effectively in the presence of epidural lesions. Mechanical stability conferred by bracing may potentiate intraosseous and extraosseous bone formation, thus increasing spinal stability. This study aims to review the role of non-operative management in myeloma patients with a high degree of spinal instability, in a specialist tertiary centre. Methods. Retrospective analysis of a prospectively collected database of 83 patients with unstable myelomatous lesions of the spine, defined by a Spinal Instability Neoplastic Score (SINS) of 13–18. Data collected include patient demographics, systemic treatment, neurological status, radiological presence of cord compression, most unstable vertebral level and presence of intraosseous and extraosseous bone formation. Post-treatment scores were calculated based on follow-up imaging which was carried out at 2 weeks for cord compression and 12 weeks for spinal instability. A paired t-test was used to identify any significant difference between pre- and post-treatment SINS and linear regression was used to assess the association between variables and the change in SINS. Results. A significant reduction in SINS was observed from a pre-treatment average score of 14 to a score of 9, following treatment for myeloma (p<0.001). A higher initial score and a younger age were associated with a larger overall reduction in SINS (p<0.001 and p=0.02 respectively). No single variable (bisphosphates, chemotherapy, radiotherapy and steroids) had a significant association with SINS reduction. 25 (30%) patients had spinal cord compression, all of which showed radiological resolution of cord compression at 2 weeks. No patients developed neurological deterioration during treatment and all patients had an improvement in their pain scores. 64 (77%) patients had evidence of intraosseous and/or extraosseous bone formation on their follow-up scan. Conclusion. Non-operative management in the form of bracing and systemic therapy is a safe and effective treatment for spinal instability and spinal cord compression in myeloma. Treatment of unstable myelomatous lesions of the spine with or without cord compression should not follow traditional guidelines for MSCC. The decision to adopt a non-operative approach in this cohort of patients should ideally be made in a tertiary centre with expertise in multiple myeloma and in a multidisciplinary setting

Lumbar disc herniation (LDH) is uncommon in youth and few cases are treated surgically. Very few outcome studies exist for LDH surgery in this age group. Our aim was to explore differences in gender in pre-operative level of disability and outcome of surgery for LDH in patients aged ≤ 20 years using prospectively collected data. From the national Swedish SweSpine register we identified 180 patients with one-year and 108 with two-year follow-up data ≤ 20 years of age, who between the years 2000 and 2010 had a primary operation for LDH. Both male and female patients reported pronounced impairment before the operation in all patient reported outcome measures, with female patients experiencing significantly greater back pain, having greater analgesic requirements and reporting significantly inferior scores in EuroQol (EQ-5D-index), EQ-visual analogue scale, most aspects of Short Form-36 and Oswestry Disabilities Index, when compared with male patients. Surgery conferred a statistically significant improvement in all registered parameters, with few gender discrepancies. Quality of life at one year following surgery normalised in both males and females and only eight patients (4.5%) were dissatisfied with the outcome. Virtually all parameters were stable between the one- and two-year follow-up examination. LDH surgery leads to normal health and a favourable outcome in both male and female patients aged 20 years or younger, who failed to recover after non-operative management. Cite this article: Bone Joint J 2015;97-B:1675–82

Spinal stenosis and disc herniation are the two most frequent causes of lumbosacral nerve root compression. This can result in muscle weakness and present with or without pain. The difficulty when managing patients with these conditions is knowing when surgery is better than non-operative treatment: the evidence is controversial. Younger patients with a lesser degree of weakness for a shorter period of time have been shown to respond better to surgical treatment than older patients with greater weakness for longer. However, they also constitute a group that fares better without surgery. The main indication for surgical treatment in the management of patients with lumbosacral nerve root compression should be pain rather than weakness

Adolescent idiopathic scoliosis affects about 3% of children. Non-operative measures are aimed at altering the natural history to maintain the size of the curve below 40° at skeletal maturity. The application of braces to treat spinal deformity pre-dates the era of evidence-based medicine, and there is a paucity of irrefutable prospective evidence in the literature to support their use and their effectiveness has been questioned. This review considers this evidence. The weight of the evidence is in favour of bracing over observation. The most recent literature has moved away from addressing this question, and instead focuses on developments in the design of braces and ways to improve compliance. Cite this article: Bone Joint J 2013;95-B:1308–16

Introduction. Spinal conditions commonly cause pain and disability. Various non-operative treatments including acupuncture are practiced for these conditions. Aim. To evaluate the effectiveness of acupuncture in management of common spinal conditions. Methodology. Between Jan 2011 and Feb 2013, 151 patients who received manual acupuncture in a hospital environment were assessed for pain improvement on Numerical-rating- scale (NRS) of 0–10, overall improvement with Core Outcome Measure Index (COMI) and for satisfaction with the care. Results. 110 had low back pain with and or radicular symptoms, 33 had neck pain and or radicular symptoms, 05 had thoracic and 04 multilevel symptoms. Average number of session given were 3.98 (range 2 to 8). Minimum and maximum reported pain improved statistically from 4.17 to 2.94 (Df 1.2, p = 0.00) and 8.00 to 6.03 (Df 1.9, p = 0.00) respectively but were below Minimum Clinically Important Difference (MCID) of 2. COMI improved statistically from 6.39(SD1.6) to 5.37 (SD 1.9) (Df 1.02, p = 0.00) that was below group MCID of COMI of 2.6. Seventy-five required further treatment, 49 were discharged and 11 patient did not complete the treatment. Discussion. Acupuncture is an NICE recommended established adjuvant treatment for treating common spinal conditions. This study demonstrates it to a be a safe technique with high patient satisfaction with statistically significant improvement in outcome measures that are below MCID of improvement raising questions on its cost effectiveness in routine clinical practice

Purposes of the study. The most common fracture of the cervical spine in the elderly population is a fracture of the odontoid peg. Such fractures are usually not displaced and these are commonly treated non-operatively. Rarely though, peg fractures are displaced and then their management is less straightforward. This is in part because the group of patients who sustain them frequently have complex and pre-existing medical co-morbidities and in part because a new neurological injury may have been sustained as a result of the peg fracture itself. Many options for the management of displaced peg fractures, both operative and non-operative have been described in the literature and discussion continues as to which technique is superior and in which patient population. The purpose of this study was to follow-up those patients who were managed operatively in our unit between 2007 and 2009. Methods and Results. We present our case series of 4 patients who sustained significantly displaced fractures of the odontoid peg with accompanying neurological injury, who were treated with posterior stabilisation using the Harms technique. Conclusions. We have found this method to be safe and reliable. It not only yields a good surgical outcome, but allows patients' rehabilitation to be optimised, maximising functional improvement. We believe the technique is superior to anterior stabilisation in this patient population because it utilises superior posterior bone quality and mechanical fixation. The approach in our unit is to treat elderly patients with displaced odontoid peg fractures according to the same principles as would be followed in managing those that have disabling injuries such as fractures of the femoral neck; early stabilisation and early mobilisation in those patients whose co-morbidities allow it

Surgical management of symptomatic lumbar degenerative disc disease (DDD) currently consists of fusion or implantation of a first generation total disc replacement (TDR). This study is the first to evaluate an elastomeric one-piece TDR in a 50-patient European study. Fifty patients with single-level, symptomatic lumbar DDD at L4-S1 who were unresponsive to at least 6-months of non-operative therapy were enrolled in a clinical trial of a viscoelastic TDR (VTDR) at three European sites. Patients were assessed clinically and radiographically at 6 weeks, 3 and 6 months, and 1 and 2 years. Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) were used to assess clinical outcomes. Twenty-eight males and twenty-two females were enrolled in the study. The average age of patients was 39.7 (23 to 61). The operative level was L4/L5 in 13 patients and L5/S1 in 37 patients. There were no intra-operative complications. Quantitative radiographic assessment indicates that the VTDR restores and maintains a physiologically appropriate disc height and angle, while providing range of motion and translation similar to those provided by the natural disc. Mean ODI scores decreased from 48% pre-operatively to 25% at two years follow up. Mean VAS low back pain scores decreased from 7.1 cm pre-op to 3 cm at two years. Median scores indicate that half of the patient population has ODI scores below 13% and VAS back pain scores below 0.5 cm. Clinically and radiologically, this elastomeric disc is performing satisfactorily, and the causes of clinical failures can be more readily identified

Introduction. The management of chronic low back pain presents a formidable challenge to the spine specialist. This study was carried out to evaluate the efficacy of percutaneous nucleoplasty in patients affected by painful disc protrusions and contained herniations. Materials and Methods. 64 Patient's data collected from 2006 to 2009 in Princess Alexandra hospital. Minimum duration of non-operative care with back pain was 6 months. Patients were considered potential candidates for the study if they reported a clinical syndrome defined by a primary report of low back pain with or without lower extremity referral pain. Results. Out of 64 patients, 54 patient's full data collected. In that 28 male and 26 female with average age of 40.21and 43.11 yrs respectively. 40 patients underwent L45 level, 4 patients at L5S1, 9 patients at L45, L5S1 levels and 1 patient at 3 levels. Average Pre Op back VAS (Visual Analog Score) score 6.66, Leg VAS score 6.14 and Oswestry disability score 45.51. At 6months follow up back VAS score 4.5, Leg VAS score 3.14 and Oswestry disability score 20.03. Longest follow up with average 22 months (range from 12-36 months) with Back VAS score 5.09, Leg VAS score 3.64 and Oswestry disability score 36.25. Average pain reduction is significant - 50%-55%, and patient satisfaction is high - about 90%. Conclusion. By overcoming the limitations of prior methods of percutaneous discectomy, DISC Nucleoplasty has demonstrated the potential to produce equivalent, or even better, outcomes in a procedure that is simpler, quicker, and less traumatic and has faster recovery-times

Introduction/Aims. An increased mortality associated with hip fractures has been recognized, but the impact of vertebral osteoporotic compression fractures (VCF) is still underestimated. The aim of this study was to report on the difference in survival for VCF patients following non-operative and operative [Balloon Kyphoplasty (BKP) or Vertebroplasty (VP)] treatments. Methods. Operated and non-operated VCF patients were identified from the US Medicare database in 2006 and 2007 and followed for a minimum of 24 months. Patients diagnosed with pathological and traumatic VCFs in the prior year were excluded. Overall survival was estimated by the Kaplan-Meier method, and the differences in mortality rates (operated vs non-operated; balloon kyphoplasty vs vertebroplasty) were assessed by Cox regression, with adjustments for patient demographics, general and specific co-morbidities, that have been previously identified as possible causes of death associated with osteoporotic VCFs. Results. A total of 81,662 operated (vertebroplasty or kyphoplasty) patients had a survival rate of 74.8% at 24 months following VCF diagnosis compared to 67.4% for the 329,303 non-operated patients. In operated (Vertebroplasty or kyphoplasty) patients there was 44% less mortality than in non-operated VCF patients (p<0.0001). The survival rates for VCF patients following vertebroplasty or kyphoplasty were 72.3% and 76.2% at 24 months, respectively. In kyphoplasty patients there was 12.5% more survival than in vertebroplasty patients (p<0.0001) after 2 years. Conclusions. This retrospective analysis, in 410,965 patients diagnosed with a VCF confirmed the statistical significant decrease (43%, p<0.0001) in mortality between patients receiving minimally invasive surgery compared to non-operated patients. Additionally the present study confirmed a statistical significant decrease (12.5%, p<0.0001) in mortality in BKP patients compared to VP patients

Aims

We aimed to establish the short- and long-term efficacy of corticosteroid injection for coccydynia, and to determine if betamethasone or triamcinolone has the best effect.

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

Aims

We performed a retrospective, comparative study of elderly patients with an increased risk from anaesthesia who had undergone either anterior screw fixation (ASF) or halo vest immobilisation (HVI) for a type II odontoid fracture.

Objectives

Loss of motion following spine segment fusion results in increased strain in the adjacent motion segments. However, to date, studies on the biomechanics of the cervical spine have not assessed the role of coupled motions in the lumbar spine. Accordingly, we investigated the biomechanics of the cervical spine following cervical fusion and lumbar fusion during simulated whiplash using a whole-human finite element (FE) model to simulate coupled motions of the spine.

Aims

Rates of mortality as high as 25% to 30% have been described following fractures of the odontoid in the elderly population. The aim of this study was to examine whether easily identifiable variables present on admission are associated with mortality.

Aims

Clinical and radiological data were reviewed for all patients with mucopolysaccharidoses (MPS) with thoracolumbar kyphosis managed non-operatively or operatively in our institution.

Aims

We reviewed 34 consecutive patients (18 female-16 male) with isthmic spondylolysis and grade I to II lumbosacral spondylolisthesis who underwent in situ posterolateral arthodesis between the L5 transverse processes and the sacral ala with the use of iliac crest autograft. Ten patients had an associated scoliosis which required surgical correction at a later stage only in two patients with idiopathic curves unrelated to the spondylolisthesis.

Aims

The purpose of this prospective study was to evaluate the outcomes of coccygectomy for patients with chronic coccydynia.

Aims

We undertook a prospective non-randomised radiological study to evaluate the preliminary results of using magnetically-controlled growing rods (MAGEC System, Ellipse technology) to treat children with early-onset scoliosis.