Aims

The aim of this study was to report the long-term prognosis of patients with multiple Langerhans cell histiocytosis (LCH) involving the spine, and to analyze the risk factors for progression-free survival (PFS).

The Walter Reed Visual Assessment Scale (WRVAS) is a valid and reliable tool, designed to measure physical deformity as perceived by patients with idiopathic scoliosis. It is unclear whether the type of treatment in patients with thoracic adolescent idiopathic scoliosis affects the patients' perception of cosmesis gain. We studied 40 patients with Adolescent Idiopathic Scoliosis treated with posterior spinal fusion with (20) and without thoracoplasty (20) aiming to assess correlation of improvement in radiological parameters to subjective cosmesis gain. Patients with Adolescent Idiopathic Scoliosis treated with posterior spinal fusion with thoracoplasty (20) and without thoracoplasty (20) filled out Walter Reed Visual Assessment Scale (WRVAS) forms with their perception of deformity before and after operation at the clinic follow-up. The WRVAS forms include seven aspects of the deformity i.e. spinal deformity, rib prominence, lumbar prominence, thoracic deformity, trunk imbalance, shoulder asymmetry and scapular asymmetry. Each aspect is shown with five figures of increasing severity of the deformity and scored from minimum (1) to maximum (5). Results are presented as the sum of the seven questions. The lowest possible score for the total is 7, while the highest possible total score is 35. The curve magnitude was divided into 5 subgroups as 30 and under, 30-40, 40-50, 50-60 and 70 and over. Floor and ceiling effects were analysed as percentage of cases with minimum and maximum scores. Our study confirmed that following posterior scoliosis surgery with and without thoracoplasty, there was significant improvement in perceived appearance. Overall spinal deformity and thoracic deformity correction were comparable in two groups. However, improvement in rib hump prominence, flank prominence, restoration of truncal, shoulder and scapular symmetry were much better rated by the patients with PSF and thoracoplasty group using Walter Reed Visual Assessment Scale

Introduction:. Shoulder balance after surgery is one main attribute of the cosmetic outcome. It has been difficult to assess on 2D images. The balance results from the interaction of rib cage, shoulder joint and scapular positions, spinal alignment and rotation, muscle size and co-ordination and pain interaction. Attempts have been made to predict shoulder balance from radiograph measurements. There is no consensus on this. Attempt:. To assess whether T1 tilt has any relation to final shoulder balance after surgery. Method:. Retrospective review of radiographs of adolescent idiopathic scoliosis patients from 2009 to 2012. 61 identified with average age of 17 and follow up of 24 months. T1 tilt is measured pre-op, immediately post-op and at the latest follow up. Radiographic shoulder balance based on soft tissue shadow is assessed at the same interval. The balance is based on eyeballed perception, which is what patients do normally. Results:. The average T1 tilt is 3.6° pre-op (−11° to 12°), changing to −2.4° (−14° to 8.2°) immediately post op and to −3.5° (−9.3° to 0.7°) at the latest follow up. The proportion of balanced shoulder improved from 14% pre-op to 14% immediately post op and to 65% at final follow up. No relation of pre-op T1 tilt and the final shoulder balance can be found. Discussion:. Shoulder balance is a dynamic feature. Patients can regain shoulder balance given time. We cannot tell whether this is due to their adaptive process or rotational movement of the spinal construct over time here. Conflict Of Interest Statement: No conflict of interest

Introduction/Aim. Intra-operative localisation of thoracic spine levels can be difficult due to anatomical constraints such as scapular shadow, patient's size and poor bone quality. This is particularly true in cases of thoracic discectomies in which the vertebral bodies appear normal. We describe a simple and reliable technique to identify the correct thoracic spine level. Methods. After induction of general anaesthesia, the patient is placed prone and the pedicle of interest is identified using fluoroscopy. A ‘K’ wire is then inserted percutaneously into this pedicle under image guidance (confirmed in the antero-posterior (AP) and lateral views). The ‘K’ wire is then cut flush and the patient is then positioned laterally and the intended procedure is performed. Results. We routinely use this technique in all our thoracic discectomies. Placing the ‘K’ wire into a fixed point like the pedicle, facilitates rapid intra-operative viewing of the level of interest and is removed easily at the conclusion of surgery. Conclusion. Per-operative placement of the ‘K’ wire avoids the patient undergoing two procedures as some of the other invasive techniques have described in the literature for correct level identification. Furthermore, this technique is simple and requires no more ability than placing an implant in the pedicle under fluoroscopy. It has the added advantage of reducing anaesthetic, surgery and fluoroscopy time

We describe three patients with pre-ganglionic (avulsion) injuries of the brachial plexus which caused a partial Brown-Séquard syndrome.

Osteoporotic vertebral compression fractures (VCFs) are an increasing public health problem. Recently, randomised controlled trials on the use of kyphoplasty and vertebroplasty in the treatment of these fractures have been published, but no definitive conclusions have been reached on the role of these interventions. The major problem encountered when trying to perform a meta-analysis of the available studies for the use of cementoplasty in patients with a VCF is that conservative management has not been standardised. Forms of conservative treatment commonly used in these patients include bed rest, analgesic medication, physiotherapy and bracing.

In this review, we report the best evidence available on the conservative care of patients with osteoporotic VCFs and associated back pain, focusing on the role of the most commonly used spinal orthoses. Although orthoses are used for the management of these patients, to date, there has been only one randomised controlled trial published evaluating their value. Until the best conservative management for patients with VCFs is defined and standardised, no conclusions can be drawn on the superiority or otherwise of cementoplasty techniques over conservative management.