Background: Prader-Willi syndrome is associated with multiple musculoskeletal manifestations including scoliosis, joint laxity, hip dyplasia and lower limb deformity. Scoliosis is reported in almost half of patients with Prader-Willi; however, only a small proportion ever have surgery. The literature suggests that surgery in this group of patients is often difficult. Obesity and apnea cause anaesthetic concern. The surgical procedure is reported as being complicated by excessive intra-operative blood loss, and difficulty with instrumentation; possibly as a result of osteopenia, is described. Purpose: To compare the experience of scoliosis surgery in Prader-Willi patients in our institution with that previously reported in the literature. Methods: The notes and x-rays of 6 patients with Prader-Willi syndrome who had corrective scoliosis were reviewed. Results: Six patients (4 female and 2male) underwent corrective scoliosis surgery. The mean age at which scoliosis was detected in the patients was 5 years (range 2–7years). The mean Cobb angle at time of initial referral was 30° (range 8°–86°). Indication for surgery in all cases was curve progression. The mean age at time of surgery was 11.8 years (range 10–13years). The mean pre-operative Cobb angle was 70° (range 40°–90°) and mean post-operative Cobb angle was 23° (range 10°–40°). Three patients had posterior surgery with instrumentation, one had anterior instrumentation only and two patients had combined anterior release with posterior instrumentation. The most proximal instrumentation levels ranged from T2–T6 and the most distal instrumentation levels ranged from T11-L5. Three patients had all pedicle screw fixation, 2 had hybrid fixation (with screws at curve apex) and one had anterior all screw fixation. The mean operative time was 335 mins (range 190–540 mins) and the mean blood loss was 29% of total blood volume (range 14–55%). Standard anaesthetic technique was used in each case and all patients were extubated immediately after surgery. Patients were discharged on average 8 days post surgery (range 6–14 days). One patient had a wound infection and a stitch granuloma requiring surgical debridement and one patient required trimming of proximal end of rod because it was prominent. Conclusion: Scoliosis surgery in patients with Prader-Willi offers adequate deformity correction and in our experience is not associated with operative technical difficulty, major complications or a prolonged hospital stay

Anterior scoliosis surgery is associated with potentially significant intra-operative blood loss, requiring homologous transfusion either intra- or post-operatively. Blood loss in this type of surgery correlates with surgical & anaesthetic techniques. In our centre the development of specific anaesthetic techniques as well as the routine use of Cell Salvage has dramatically reduced the rates of homologous blood transfusion. Currently specific indications for the use of the Cell Saver in Anterior Scoliosis have not been proven. Previous studies have commented on the beneficial aspects of recovered autologous transfusion for Orthopaedic patients in general, whilst others have shown a negligible advantage specifically in anterior thoracolumbar fusion surgery. In order to assess the cost-effectiveness of the techniques used in Anterior Scoliosis Surgery we carried out a retrospective study of 180 consecutive patients, all of whom underwent instrumented anterior scoliosis correction between July 2000 and September 2004. A cell saver was used in all the cases, and hospital data (including haematological indices and number of levels fused) was collected. The median age of the study cohort was 11.2 years (range 7 – 64), and the male:female ratio was 1:8.4. The average preoperative haemoglobin in all patients was 12.7g/dl and the average postoperative haemoglobin was 9.8g/dl. In total the rate of homologous transfusion requirement was 1 unit per 9.1 patients. Results show that homologous transfusion was required in less than 11% of all patients. This is better than previously published rates of transfusion in similar procedures. The range of volume of intra-operatively salvaged cells was 200 to 770mls. There was no correlation between the number of levels fused (extent of scoliosis corrective surgery) and units transfused. Our experience shows that the use of Salvaged Autologous Blood Transfusion in anterior scoliosis surgery has an important role in reducing the incidence of postoperative anaemia and homologous transfusion requirements

In major procedures like scoliosis surgery, parents are often asked to sign the consent on behalf of children because of the pretext that minor may have limited understanding and judgement about the procedure. Scoliosis surgery for patients with AIS is mainly indicated for cosmetic or psychological reasons. We audited our practice in the department to collect information on the current consent practices involving the minor patients undergoing scoliosis surgery. We also have conducted a questionnaire survey of the various spinal units in UK to assess their practice in this regard. Forty-two consent forms (28 patients; multiple procedures in some patients) and case notes of patients between 12 and 16 years undergoing scoliosis surgery were reviewed. We have contacted 12 spinal deformity correction units and 11 spinal trauma units across UK over telephone to assess the current consenting practice as well. 9.5% (n=4) patients signed there own consent forms. Except in one case explanation of risks were documented in detail. Except two units (18%) offering the minor patient to sign their consent, parents are usually asked to sign consent on their behalf in majority (10/12) units. Seven out of the twelve spinal units use standard NHS or department of health consent forms. Few units have their own consent form with some alterations or additions. There is no specific age when a child becomes competent to consent to treatment: It depends both on the child and on the seriousness and complexity of the treatment being proposed. However, it is still good practice to encourage competent children to more involved along with their families in decision-making

Background: Anterior scoliosis surgery is associated with potentially significant intra-operative blood loss, requiring homologous transfusion either intra- or postoperatively. Blood loss in this type of surgery correlates with surgical & anaesthetic techniques. In our centre the development of specific anaesthetic techniques as well as the routine use of Cell Salvage has dramatically reduced the rates of homologous blood transfusion. Currently, specific indications for the use of the Cell Saver in Anterior Scoliosis Surgery have not been proven. Previous studies have commented on the beneficial aspects of autologous transfusion for Orthopaedic patients in general; However, others have shown a negligible advantage specifically in anterior thoracolumbar fusion surgery. The aim of our study was to assess and quantify the use of homologous blood, as well as the effects on haematological indices. Methods: We carried out a retrospective study of 144 consecutive patients, all of whom underwent instrumented anterior scoliosis correction between April 2001 and October 2004. A cell saver was used in all the cases, and hospital data (including haematological indices and number of levels fused) was collected. Results: The median age of the study cohort was 15.0 years (range 8 – 46), and there were 31 males and 113 females. The mean preoperative haemoglobin in patients was 13.5g/dl and the mean postoperative haemoglobin was 10.6g/dl. Haematocrit values followed a similar pattern, the mean pre-op value being 0.41, mean post-op value was 0.29. The range of volume of intra-operatively salvaged cells was 200 to 1100mls. 25 of 144 patients required transfusion. In these patients, the average number of units given was 2.3, although the total homologous transfusion rate was 0.4 units per patient. Results show that homologous transfusion was not required in 82.6% of patients. This is better than previously published rates of transfusion in this procedure. There was no correlation between the number of levels instrumented and the number of units transfused (Pearson Correlation Coefficient 0.19), and no correlation between the number of levels instrumented and postoperative haematocrit values (Pearson Correlation Coefficient 0.16). None of the patients required intra-operative homologous transfusion. Conclusion: Our experience shows that along with meticulous surgical haemostasis, and hypotensive anaesthesia the use of Salvaged Autologous Blood Transfusion in anterior scoliosis surgery has an important role in reducing the incidence of postoperative anaemia and homologous transfusion requirements

Orthopaedic paediatric deformities, globally, are often corrected later than initial identification due to resource constraints (bed availability, investigative modalities, surgical skill set). The study aims to analyse experiences and challenges met with running a flagship scoliosis surgery week in a tertiary public health care facility, with the goal of reducing patient waiting time on the waiting list.

In this retrospective study, patients from an existing deformity correction waiting list were selected for a 5 day scoliosis surgery week. Investigations relevant to clinical findings were carried out and patients were scheduled on a “one patient per day” surgery list. Inclusion criteria was any patient with adolescent idiopathic scoliosis of varying degree that was symptomatic. Exclusion criteria was any other deformity of any age.

Outcomes measured include: Administrative hurdles (obtaining funding, organising ward and ICU beds, getting nursing staff), Surgical challenges (severity of the curve, intraoperative time, approach chosen) and perioperative management (anaesthesia, pain management, cost of equipment) will be looked at to better define the experiences and challenges.

All scheduled surgeries were completed. This meant more cases were carried out than what was done in the last 2 years at the facility combined. Lack of Nursing staff availability and few ICU beds delayed starting cases. Anterior fusion took a shorter surgical time in comparison to posterior and cost far less to carry out owing to deformity severity. Intra and post operative management also varied due to daily changes in theatre staff and a lack of standardized protocols.

Running a scoliosis surgery week helps to lower the waiting time for deformity correction in public health care facilities. Pre organising resources results in more successful outcomes and an increase in the number of cases done over a shorter period.

Increasing health care costs, limited resources and increased demand makes cost-effective and cost-efficient delivery of Adolescent Idiopathic Scoliosis (AIS) management paramount. Rising implant costs in deformity surgery have prompted justification of high implant density. The objective of this study was to analyse the costs of thoracoscopic scoliosis surgery, comparing initial learning curve costs with those of the established technique and to the costs involved in posterior instrumented fusion from the literature. 189 consecutive cases from April 2000 to July 2011 were assessed with a minimum of 2 years follow-up using a prospective database covering perioperative factors, clinical and radiological outcomes, complications and patient-reported outcomes. The patients were divided into three groups to allow comparison; 1. A learning curve cohort, 2. An intermediate cohort and 3. A third cohort using our established technique. Hospital finance records and implant manufacturer figures were corrected to 2013 costs. A literature review of AIS management costs and implant density in similar curve types was performed. The mean pre-op Cobb angle was 53°(95%CI 0.4) and was corrected postop to mean 22.9°(CI 0.4). The overall complication rate was 20.6%, primarily in the first cohort, with a rate of 5.6% in the third cohort. The average total costs were $46,732, operating room costs of $10,301 (22.0%) and ICU costs of $4620 (9.8%). The mean number of screws placed was 7.1 (CI 0.04) with a single rod used for each case giving average implant costs of $14,004 (29.9%). Comparison of the three groups revealed higher implant costs as the technique evolved to that in use today, from $13,049 in Group 1 to $14577 in Group 3 (P<0.001). Conversely operating room costs reduced from $10,621 in Group 1 to $7573 (P<0.001) in Group 3. ICU stay was reduced from an average of 1.2 to 0 days. In-patient stay was significantly (P=0.006) lower in Groups 2 and 3 (5.4 days) than Group 1 (5.9 days). Our thoracoscopic anterior scoliosis correction has evolved to include an increase in levels fused and reduction in complication rate. Implant costs have risen, however, there has been a concurrent decrease in those costs generated by operating room use, ICU and in-patient stay with increasing experience. Literature review of equivalent curve types treated posteriorly shows similar perioperative factors but higher implant density, 69–83% compared to the 50% in this study. Thoracoscopic Scoliosis surgery presents a low density, reliable, efficient and effective option for selected curves

Children undergoing posterior spinal fusion (PSF) for neuromuscular and syndromic scoliosis were admitted to the paediatric intensive care (PIC) until about 6 years ago, at which time we created a new unit, a hospital floor-based spinal high-dependency unit-plus (SHDU-plus), in response to frequent bed-shortage cancellations. This study compares postoperative management on PIC with HDU-plus for these non-hospital floor suitable children with syndromic and neuromuscular scoliosis undergoing PSF.

Retrospective review of 100 consecutive children with syndromic and neuromuscular scoliosis undergoing PSF between June 2016 and January 2022. Inclusion criteria were: 1) diagnosis of syndromic or neuromuscular scoliosis, 2) underwent PSF, 3) not suitable for immediate postoperative hospital floor-based care. Exclusion criteria were children with significant cardio-respiratory co-morbidity requiring PIC postoperatively.

55 patients were managed postoperatively on PIC and 45 on SHDU-plus. No significant difference between groups was found with respect to age, weight, ASA grade, preoperative Cobb angles, operative duration, number of levels fused and estimated blood loss. 4 patients in the PIC group and 1 in the SHDU-plus group were readmitted back to PIC or HDU following step-down to the hospital floor. Average length of stay was 2 days on PIC and 1 day on SHDU-plus. Average total length of hospital stay was 16.5 days in the PIC group and 10.5 days in the HDU-plus group. 19 (35%) patients developed complications in the PIC group, compared to 18 (40%) in SHDU-plus. Mean specialist unit charge per day was less on SHDU-plus compared with PIC. There were no bed-shortage cancellations in the SHDU-plus group, compared to 11 in the PIC group.

For children with neuromuscular or syndromic scoliosis undergoing PSF and deemed not suitable for post-operative care on the hospital floor, creation of a SHDU-plus was associated with fewer readmissions back to PIC or HDU, shorter hospital stays, an equivalent complication rate, significant cost-saving and fewer cancellations. Level of Evidence: Therapeutic Level III.

Seniors make up 16.9 percent of the Canadian population. Furthermore, the number of Canadians who are 65 years or older is increasing at an average rate of 20 percent every 5 years. In 2017, Sing etal reported that there is an increasing number of patients undergoing degenerative scoliosis surgery with the largest increase attributed to patients aged 65–69 years followed by those aged 70–74 years. Therefore, the purpose of this study is to assess the effectiveness of undergoing spinal surgery to correct degenerative spinal scoliosis in the ever-growing number of elderly patients. We hypothesize that age is not an independent prognostic factor of patients' outcomes followings degenerative scoliosis surgery.

A retrospective review of prospectively collected data within the Canadian Spine Outcome and Research Network (CSORN) was conducted. Data was analyzed using IBM-SPSS. ANOVA was used to analyze continuous variables while Chi Square test was used to analyze categorical variables. Significance level was p < 0.05.

There were 165 patients identified from the registry who met the inclusion criteria, 94 patients (57 %) were female. There were 102 (61.8 %) patients who were 65 years or older. The overall average age was 66.6 years (range 35–84, SD 8.6). There were 27 intra-operative complications, 44 peri-operative complications and 18 post operative complications. There was no statistically significant difference between the two age groups with regards to risk of developing intra-operative, perioperative and post operative complications. Patients who underwent degenerative scoliosis surgery reported an average improvement of 2.95±3.32, 3.64±3.50, 16.84±20.44 points on the back-pain scale, leg pain scale and the Oswestry Disability Index (ODI) respectively, there was no statistically significant differences in these measures between the two age groups.

As the number of patients undergoing degenerative scoliosis surgery increases, clinicians will need to determine which factors will significantly impact patients' outcomes following surgery. This study shows that age is not an independent prognostic factor when it comes to patients' outcomes following degenerative scoliosis surgery. In the future, research should examine the impact of age in conjunction with factors such as frailty, comorbidities and functional status on patient outcomes.

PURPOSE

This study aims to identify the incidence and factors influencing readmissions following scoliosis surgery over a period of 19 years.

This is an outcome study of patients with spina bifida treated for scoliosis by anterior and posterior spinal surgery at the Starship Children’s Hospital.

The clinical notes and radiographs were reviewed of all spina bifida patients with scoliosis undergoing surgery between January 1991 and January 2001. In addition all patients were sent the Spina Bifida Health Related Quality of Life Questionnaire (HRQOL) and the Spina Bifida Spine Questionnaire (SBSQ). There were 19 consecutive patients with an average age at surgery of 13 years 5 months. Four patients had both anterior and posterior instrumentation. 14 patients had staged procedures.

There was an overall improvement in scoliosis of 61% and pelvic obliquity of 70% at latest follow-up that averaged 60 months. The major complications included 4 deep infections and 2 pseudarthroses. The patients scored an average of 68.8 on the SBSQ. The average score for 5–12 years old was178 and for 13–30 years old, 163, on the HRQOL questionnaire. There are good radiological results with combined anterior/posterior surgery in this group of spina bifida patients. Quality of Life does not seem to be greatly compromised in the operated spina bifida patient.

We recommend early single stage anterior and posterior fusion for these patients before the curve becomes too large and stiff.

There is a high incidence of spinal deformity in children with the Prader-Willi syndrome. We have encountered major complications following spinal surgery in this condition. We report our experience and conclude that spinal surgery is a formidable undertaking and the risks should be appreciated by the surgeon and the parents.

Purpose: To evaluate the indications, outcome, risk factors and complications of transpedicular osteotomy (TPO) in revision scoliosis surgery

Methods: We evaluated patients undergoing TPO for revision scoliosis surgery at our institution between 1989 and 2004 with a minimum follow up of 18 months. Demographic data, anaesthetic risk factors, peri-operative data and complications were recorded. Radiographs pre-operatively, post-operatively and at last follow up recorded sagittal balance, coronal balance, lumbar lordosis and pelvic parameters. Functional outcome was measured using the Whitecloud score.

Results: 21 patients (24 TPO’s) mean age 48.7 years with mean follow up 4.4 years fulfilled criteria for study. All cases had fixed sagittal imbalance pre-operatively. Mean operative time was 4.6 hours and mean transfusion requirement was 2.3. units. A significant improvement (p< 0.03) in sagittal imbalance was gained (although in 3 cases of pseudarthroses this was partially lost) and the post-operative lumbar lordosis correlated closely significantly pelvic incidence (p< 0.03). Functional outcome was good/excellent in 67% cases.

We report 28 complications. 22 early included 4 dural tears, cardiac decompensation with reduction, 5 neurological deficits including a parpaplegia secondary to haematoma which was evacuated and the patient made a good recovery at 6 months, 2 UTIs, IVI infection, superficial wound infection and extension of metalwork due to early proximal decompensation. Late complications included infection (8 years), removal of prominent metalwork, radiculopathy due to screw (6 months) and 3 pseudarthroses. There was no statistically significant correlation of complication with weight, ASA grade or smoking.

Conclusion: TPO in revision scoliosis is an effective method of correcting both coronal and sagittal imbalance but is not without complication, although good functional outcome is achieved in most patients. It is important to consider pelvic parameters pre-operatively to plan the level and magnitude of TPO required.

Introduction The use of anterior techniques to address scoliosis is well established. The method employed is dependent on the curve type, degree and the institution. There are apparent immediate perioperative advantages of an endoscopic technique over an open thoracotomy. In addition, endoscopic instrumentation and fusion has become accepted as a reliable method to address thoracic scoliosis.

Methods 101 patients have undergone anterior endoscopic instrumented correction for scoliosis at the Mater Children’s Hospital, Brisbane between 2000 and 2005. In 2002, a case series study was established to assess perioperative aspects. The majority of patients were entered into a database prospectively. A total of 83 patients were included in the study at the point of data analysis for this paper. The perioperative factors considered were: Theatre times; Blood management; Mobility; and Complications.

Results The mean age was 16 years. 75 curves were adolescent idiopathic. Eight curves were in neuromuscular patients. The majority, 59 (79%) were Lenke Type 1 curves. Operating times were divided into anaesthetic, surgical and X-ray. There was a mean reduction in anaesthetic time between the first and last 20 cases of 22 minutes (p=0.20). For X-ray this was 73 seconds (p< 0.001). The mean surgical time was 288 minutes. The mean reduction in surgical time was 76 minutes (p< 0.001). A scatter plot was also performed of surgical time versus case number. The surgical time has an apparent plateau after approximately 30 cases. This may suggest a learning curve of this number. The mean intra-operative blood loss was 380mls with no allogenic transfusions. The mean length of stay was 5.8 days. There was an overall perioperative complication rate of 12%. There were six reinsertions of ICC, one conversion to an open thoracotomy, two postoperative chest infections and one patient requiring re-intubation in intensive care due to narcosis. There were no subsequent problems for these patients with perioperative complications.

Discussion The use of endoscopic techniques to address scoliosis is employed in centres specializing in spinal deformity. The results above are comparable to those previously reported for both open and endoscopic anterior techniques. The results outlined demonstrate this to be a safe method regarding the perioperative morbidity and complications associated with the procedure.

Background: Long waiting lists in the NHS are a cause for public concern especially with regards to progressive conditions like scoliosis. We reviewed records to 61 patients to ascertain whether waiting time had any detrimental influence on their surgical management.

Methods: Retrospective review. Assessment of clinical records and radiographs of 61 patients who had scoliosis surgery over past two years was done by two independent investigators. Patient demographics, waiting times between referral and outpatient review and waiting time for surgery were collected.

Results: There were 41 females and 20 males with mean age of 11.8 years (range, 1– 22 years). Thirty-four patients had thoracic curves (28- right sided), 21 had thoracolumbar curves (19- right sided) and 6 patients had right sided lumbar curves. Mean Cobb angle at presentation was 58° (range,17°–90°) which increased to 71°(range, 30°–120°) at surgery. Average waiting time to be seen in the clinic was 16 months. Average waiting time for surgery was 10 months. Rapid curve progression was seen in twelve patients (20%), of which 10 required more extensive surgery than originally planned. Their mean Cobb angle at presentation was 48° (range, 45°– 80°), which increased to a mean of 59° at surgery (range, 50°–92°). At presentation their Risser grades were: 5 – grade 0, 3- grade 2, 2- grade 4. These 10 patients had waited averagely 7.8 months to be seen in the clinic and for 11 months to have the surgery.

Conclusion: Significant curve progression occurred in 20 % of patients waiting to have scoliosis surgery. Ten of those required much more extensive surgery than originally planned. Long waiting times therefore have a detrimental effect on the surgical management of scoliosis patients.

Objective: To assess the cardiology of continuous ECG of Spinal Surgeons performing complex spinal deformity surgery.

Design: Spinal surgeons were attached to 24 hour tape ECG monitors while performing spinal deformity surgery. Pre op, intra-op and immediate post op assessment were performed.

Subjects: 4 Consultants 1 Spinal Fellow

Outcome measures: ECG changes, Heart Rate variance and Heart Rate

Results: Variability in Heart rate was related to the experience of the surgeon and the case performed.

Heart rate variance was highest in the Consultant with the most recent appointment. Heart rate variance in the Trainee was the lowest. The highest heart rate was achieved when scrubbed supervising the surgical trainee. The surgeons with the highest deformity work load had the lowest intra-operative heart rate

Conclusions: Spinal deformity surgery is stressful to the Consultant performing the case. Experience and case mix affect these findings. The highest stress rate occurs with supervising trainees.

Introduction: Endoscopic techniques are an established technique for anterior correction and instrumentation of thoracic scoliosis. Deterioration in respiratory function post thoracotomy for has been cited as a disadvantage of anterior approaches and led certain authors to recommend posterior methods¹. Endoscopic techniques may reduce respiratory complications and respiratory compromise in both the short and long term.

Methods: Thirty eight patients, 7 male 31 female, mean age 17.3 yrs (11– 37yrs) have undergone endoscopic scoliosis surgery under the senior author. Indication for surgery was idiopathic scoliosis 36 and an underlying syrinx 2. All patients undergoing endoscopic scoliosis surgery have a standard preoperative assessment including respiratory function tests (RFTs). All patients have been followed up prospectively (mean 15 months, range 3 – 33 months) and standard data recorded. As part of this study we are in the process of performing follow up RFTs on all patients.

Results: Preoperatively no significant respiratory function compromise attributable to the scoliosis has been detected. Mean duration of intercostal drain was 2 days, one patient requiring reinsertion for a recurrent pneumothorax. No other major respiratory complication occurred. On average patients were fully mobile by day five and mean hospital stay was 6 days (4–10 days). Provisional RFTs postoperatively have shown no significant change.

Discussion: Our provisional results indicate that endoscopic scoliosis correction and instrumentation does not lead early respiratory complications or to a significant deterioration in respiratory function of the patient.

INTRODUCTION: Endoscopic techniques are an established technique for anterior correction and instrumentation of thoracic scoliosis. Deterioration in respiratory function post thoracotomy has been cited as a disadvantage of anterior approaches and led certain authors to recommend posterior methods¹. Endoscopic techniques may reduce respiratory complications and respiratory compromise in both the short and long term.

METHODS: Thirty eight patients, seven male 31 female, mean age 17.3 years (11– 37 years) have undergone endoscopic scoliosis surgery under the senior author. Indication for surgery was idiopathic scoliosis 36 and an underlying syrinx 2. All patients undergoing endoscopic scoliosis surgery have a standard pre-operative assessment including respiratory function tests (RFTs). All patients have been followed up prospectively (mean 15 months, range 3 – 33 months) and standard data recorded. As part of this study we are in the process of performing follow up RFTs on all patients.

RESULTS: Pre-operatively no significant respiratory function compromise attributable to the scoliosis has been detected. Mean duration of intercostal drain was two days, one patient requiring reinsertion for a recurrent pneumothorax. No other major respiratory complication occurred. On average patients were fully mobile by day five and mean hospital stay was six days (4–10 days). Provisional RFTs post-operatively have shown no significant change.

DISCUSSION: Our provisional results indicate that endoscopic scoliosis correction and instrumentation do not lead to early respiratory complications or to a significant deterioration in respiratory function of the patient.

The use of blood transfusion in elective spinal surgery still remains a topic of debate in spite of several guidelines on transfusion in orthopaedic surgery. We report on a study done to look at the transfusion practice in 64 patients who underwent scoliosis correction surgery in our institution. There were 16 males and 48 females, with an average age of 19.8 years (range 3–70 years). There were 50 patients with idiopathic scoliosis, seven with degenerative scoliosis, five with neuromuscular scoliosis, and one each of congenital and neurologic scolioses. 31 of the patients underwent posterior correction and 13 patients underwent anterior surgery and 11 patients underwent posterior surgery with costoplasty and 5 patients underwent front and back surgery while 4 patients had front and back surgery with costoplasty. 10 patients underwent iliac crest bone grafting. The mean preop haemoglobin was 13.1 g % (range11.3–16.2 g %) and the mean postop haemoglobin was 8.9 g % (5–14.9 g %). The average amount of intraoperative fluids infused was 4100 ml (range: 300–11000 ml). The mean blood loss was 803.3 ml (range: 300–1800 ml). Sixteen patients were transfused in all requiring 32 units of blood, with an average of 2 units per patient. The average duration of hospital stay was 10.1 days (5–45 days). The mean blood loss through drains was 396 ml (10–2000 ml).

Aim: This study measures the outcomes of surgery for neuromuscular scoliosis using patient/ carer goal setting techniques.

Method and Results: In neuromuscular scoliosis, the objective of surgery is to maintain or improve sitting ability and to improve overall function. Measuring the outcome of surgery by patient/carer grading of patient/ carer set goals has not been used in this patient group.

A group of 20 children who underwent spinal fusion for neuromuscular scoliosis were assessed using a postural and functional measure pre-op, post-op, and at 3 and 12 months post-op. In addition, each patient was asked to record three goals for undergoing the surgery. At one year post op, patient/carers were asked to grade on a scale of 0 – 10, how satisfied they were that the goals had been achieved.

Nineteen patients had clear pre-op goals for the surgery relating to functional activities. The most frequent goals stated for the non-ambulant children were- sitting for longer periods (7/46), making dressing easier (7/46) and sitting more upright (6/38). There were 15 other functional goals stated. The ambulant children stated- appearing straighter (3/12), increase in confidence (2/12), reducing pain (2/12) and maintaining respiratory function (2/12). There were 3 other functional goals stated. Seventeen patients completed the study, 2 were lost to follow up, 1 died. The average satisfaction rate from goals achieved 1 year post-op was 7.9/10.

Conclusion: Establishing goals that are realistic and contribute positively to the functional ability or practical management of the child with neuromuscular scoliosis undergoing spinal surgery, encourages the family to be central in the decision making process. It also allows unrealistic expectations to be discussed pre-op and represents the most patient centred method of outcome assessment.

Purpose

To evaluate efficacy of blood conservation strategies on transfusion requirements in adult scoliosis surgery and establish a protocol for cross matching.