Aim:. To review the use of traction x-rays under anaesthesia in Late Onset Scoliosis to correlate traction x-ray flexibility and postoperative correction using posterior nonsegmental all pedicle screw constructs. Methods:. Prospective study. Preoperative anteroposterior, lateral and side bending x-rays were done and Cobb angles were measured. Intraoperatively, traction anteroposterior x-rays were taken under anaesthesia and Cobb angles were measured. All patients underwent nonsegmental posterior all pedicle screw construct correction using Biomet implants. Cobb angles greater than 60 degees were included in the study. Calculations were done including correction rate, traction flexibility and traction correction index. Results were entered onto an excel spreadsheet and analyzed using Statistica software. Results:. 16 patients were studied, 3 boys and 13 girls, average age 14, ranging from 8 to 17 years. Preoperative Cobb angles were mean 82 (60 to 105) degrees. Traction x-rays mean Cobb angle was 42 degrees with mean traction flexibility rate 49%. Mean correction rate was 65% and mean traction correction index 106. Preoperative Cobb angles correlated with traction flexibility with a p value of 0.01. Traction x-rays Cobb angle correlated with the traction correction index (p = 0.003), postoperative x-rays (p = 0.000) and also with correction rate (p = 0.024). There was no correlation between preoperative Cobb angle and correction rate. Conclusion:. Traction x-rays under anaesthesia in late onset scoliosis are a good predictor of postoperative correction with posterior nonsegmental all pedicle screw constructs in curves greater than 60 degrees

Introduction. There are controversies in the literature about thoracoplasty and its effect on lung function changes. The aim of the study was to evaluate the effect and outcome of thoracoplasty in conjunction with pedicle screw construct in the treatment of thoracic adolescent idiopathic scoliosis on lung functions. Materials and methods. It is a retrospective study of consecutive series of 62 patients with thoracic adolescent idiopathic scoliosis surgically treated by single surgeon between 2007 and 2008 at a tertiary referral Orthopaedic Spinal unit. Posterior spinal fusion and thoracoplasty (n=32, all but one girls) were compared with 30 without thoracoplasty (all but one girls). Clinical and radiographic analysis was performed, including the SRS-30 questionnaire and Pulmonary Function Tests (PFT). Absolute and percent-predicted values of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and total lung capacity (TLC) were evaluated preoperatively and at 3-months, 1 year and/or 2-year follow-up, and comparisons were made between two groups. The minimum follow-up was one year. Results. No statistical differences were found between the two groups in PFT's both pre-operatively and at latest follow up ranging 1 to 3 years. Our findings suggest that thoracoplasty did not adversely affected long-term PFT's in AIS patients compared to patients treated by posterior spinal fusion alone. Three-month postoperative pulmonary function test values in both groups experienced 15–30% decline which returned to the preoperative baseline at 1 year in > 90% patients. In thoracoplasty group, 5 to 8 ribs were resected and used for bone graft. Chest complications were observed in 2 patients requiring chest drainage. Prolonged donor site morbidity was noted in 3 patients. Conclusions. Thoracoplasty showed comparable clinical and radiological correction without any significant pulmonary function compromise. Pulmonary function test values returned to the preoperative baseline at 1 year in > 90% patients

Purpose of the study. The aim of the study was to review the surgical management of Neuromuscular Scoliosis (NMS) and its outcome. Method. NMS patients who underwent surgery between 2001 and 2012 were identified. Case notes, surgical data, complications and radiographic results were reviewed retrospectively. The families were contacted telephonically. Sitting posture status and whether the parents and patients would opt to have the surgery again if given the opportunity, was assessed. Summary of Results. 96 NMS patients had corrective spinal surgery performed by a single surgeon in 4 institutions. Cerebral Palsy was the most common underlying cause (18) followed by Myelomeningocoele (15), SMA (12) and post spinal cord injury scoliosis (10). 52 patients were female and 44 male with a median age of 13.6 years at surgery. The delay to surgery after presentation was 20.6 months. Seventy patients received posterior only based surgery and 12 patients had anterior only fusions. Another 12 patients had a 2-stage procedure with a delay of 12 days between operations. The average blood loss was 1600ml and duration of surgery 222 minutes. Forty seven patients had pedicle screw only constructs and 46 patients' constructs included the pelvis. An average of 14.2 levels were included in the construct. The primary curve was corrected from 84.4° to 32.7° which was mostly maintained throughout the follow-up period. 55 patients had a follow-up of greater or equal to 2 years. Only one patient reported not having improved his sitting posture. 3 parents and 5 patients would opt not to have the surgery again. Conclusion. Spine fusion in NMS is effective in correcting and maintaining correction of associated scoliosis despite the risk of major complications. Most patients and family value the clinical improvement and would agree to surgery again. NO DISCLOSURES