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.

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.

Background

The incidence of scoliosis is 2/1000 population in the UK with 80% being idiopathic. In the Royal Victoria Hospital, Belfast there are approximately 25 scoliosis operations per year, the majority are for idiopathic causes and are limited to posterior instrumentation and fusion. It is current practice in this hospital to use a cell salvage machine for every case managed by nursing staff.

Background

Accurate insertion of pedicle screws in scoliosis patients is a great challenge for surgeons due to the severe deformity of thoracic and lumbar spine. Meanwhile, mal-position of pedicle screw in scoliosis patients could lead to severe complications. Computer-assisted navigation technique may help improving the accuracy of screw placement and reducing complications. Thus, this meta-analysis of the published researches was conducted concentrating on accuracy of pedicle screw placement and postoperative assessment in scoliosis patients using computer-assisted navigation technique.

Introduction

Radiographic parameters have been shown to have a poor correlation with clinical outcome after open scoliosis procedures. However this has not been previously addressed after endoscopic surgery. The purpose of our study was to examine prospectively the relationship between curve correction and clinical outcome for endoscopic scoliosis surgery.

Aim

Nasal colonization with S.aureus (SA) is a risk factor for developing nosocomial infections in cardiac surgery. However, the risk in orthopedic surgery remains unclear, especially in adolescent idiopathic scoliosis (AIS) surgery were data are missing. This study aims to evaluate the efficacy of a preoperative nasal decontamination program in SA healthy carriers on early surgical site infections (SSI) after AIS posterior surgery in a pediatric universitary Parisian hospital.

The relationship between radiologic union and clinical outcome in thoracoscopic scoliosis surgery is not clear, as apparent non-union does not always correspond to a poor clinical result. Our aim was to evaluate CT fusion rates 2yrs after thoracoscopic surgery, and explore the relationship between fusion scores and; (i) rod diameter, (ii) graft type, (iii) fusion level, (iv) implant failure, and (v) lateral position in disc space.

Between 2000 and 2006 a cohort of 44 patients had thoracoscopic scoliosis correction. Discectomies were performed and defect was packed with either autograft (n=14) or allograft (n=30). Instrumentation consisted of either 4.5mm (n=24) or 5.5mm (n=20) single titanium anterior rod and vertebral body screws. Fusion quality and implant integrity were evaluated 2yr following surgery using low-dose CT. At each disc space, left, right and mid-sagittal CT reconstructions were generated and graded using the Sucato 4-point scale (Sucato, 2004) which is based on calculated percentage of fusion across disc space.

Fusion scores were measured for 259 disc spaces in 44 patients. Rod diameter had a strong effect on fusion score, with a mean score of 2.12±0.74 for 4.5mm Ti rod, decreasing to 1.41+0.55 for 5.5mm Ti rod, and to 1.09+0.36 for 5.5mm Ti-alloy rod. Mean fusion scores for autograft and allograft subgroups were 2.13±0.72 and 2.14±0.74 respectively. Fusion scores were highest in the middle of implant construct, dropping off by 20–30% toward the ends. Fusion scores adjacent to the rod (2.19±0.72) were significantly higher than on the contralateral side of the disc (1.24±0.85). Levels where rod fracture occurred (n=11) had lower fusion scores than those without fracture (1.09±0.67 vs 1.76±0.80). Levels where top screw pullout occurred (n=6) had lower CT fusion scores than those without (1.25±0.60 vs 1.83±0.76).

Rod diameter (larger), intervertebral level (proximal or distal), lateral position in disc (further from rod) and rod fracture or screw pullout all reduce fusion scores, while graft type does not affect scores. The assumed link between higher fusion score and better clinical outcome must be treated with caution, because rod fractures did not necessarily occur in patients with lower fusion scores. It is possible that with a stiffer rod, less bony fusion mass is required for a stable construct. We propose that moderate fusion scores secure successful clinical outcomes in thoracoscopic scoliosis surgery.

Purpose

1. To evaluate how radiological parameters change during the first 3 years following anterior endoscopic surgery. 2. To report complications encountered in this period.