The standard approach of diagnosing and monitoring scoliosis involves using the Cobb angle from posteroanterior (PA) radiograph. This approach has two key limitations: 1) It involves exposing the patients to ionising radiation during a period of heightened radiosensitivity. 2) The 2D x-ray image is a projection image of a 3D deformity and the Cobb angle represents only lateral rotation. 3DUS would overcome both these limitations. We developed a 3DUS system by combining motion capture technology, a conventional 2D ultrasound scanner and bespoke software. An ex vivo experiment and a pilot clinical study were carried out to demonstrate the system's ability in identifying vertebrae landmarks and quantifying the curvature. For the ex vivo validation, a spine phantom was created by 3D-printing a segmented abdo-pelvis CT scan. The spine phantom was then scanned using 3DUS and the level of agreement in the dimensions measured using 3DUS and CT was assessed. An 11 year old female with adolescent idiopathic scoliosis (AIS) was scanned with 3DUS. The SP co-ordinates were projected on a plane of best-fit to compare the curvature angle from 3DUS with the Cobb angle from the x-ray image. The spinous (SP), transverse processes and the laminae demonstrated high echogenicity and were easily identifiable. The difference between the spine phantom inter-SP dimension measurements made in 3DUS and CT was <2.5%. The PA x-ray of the AIS patient revealed 47° (L4-T11) and 52° (T6-T11) curves. 3DUS was able to represent the deformity in 3D revealing complex curvatures in all planes. The curvature angle from derived from 3DUS for the L4-T11 and T6-T11 curves were 132° (48°) and 125° (55°) respectively. The results of this pilot study demonstrate 3DUS as a promising tool for imaging spine curvature

Aims

This multicentre, retrospective study aimed to improve our knowledge of primary pyogenic spinal infections in children by analyzing a large consecutive case series.

The outcome of 56 children (61 shoulders) treated surgically at the Rizzoli Institute between April 1975 and June 2010 for congenital elevation of the scapula is reported. There were 31 girls and 25 boys with a mean age at surgery of 6.4 years (2 to 15). The deformity involved the right shoulder in 20 cases, the left in 31 and was bilateral in five. The degree of the deformity was graded clinically and radiologically according to the classifications of Cavendish and Rigault, respectively. All patients underwent a modified Green procedure combined, in selected cases, with resection of the superomedial portion of the scapula and excision of any omovertebral connection. After a mean follow-up of 10.9 years (1 to 29.3), there was cosmetic improvement by at least one Cavendish grade in 54 shoulders (88.5%). The mean abduction of the shoulder improved from 92° (50° to 155°) to 112° (90° to 170°) and the mean flexion improved from 121° (80° to 160°) to 155° (120° to 175°). The unsatisfactory cosmetic result in seven shoulders was due to coexistent scoliosis in two cases and insufficient reduction of the scapular elevation in the other five. An incomplete upper brachial plexus palsy occurred post-operatively in three patients but resolved within seven months.

We suggest that a modified Green procedure combined with resection of the superomedial portion of the scapula provides good cosmetic and functional results in patients with Sprengel’s shoulder.

We retrospectively reviewed the records of 16 children treated for spondylodiscitis at our hospital between 2000 and 2007. The mean follow-up was 24 months (12 to 38). There was a mean delay in diagnosis in hospital of 25 days in the ten children aged less than 24 months. At presentation only five of the 16 children presented with localising signs and symptoms. Common presenting symptoms were a refusal to walk or sit in nine children, unexplained fever in six, irritability in five, and limping in four. Plain radiography showed changes in only seven children. The ESR was the most useful investigation when following the clinical course of the disease. Positive blood cultures were obtained in seven children with Staphylococcus aureus being isolated in five. Antibiotics were used in 14 children and spinal bracing in six. Children with spondylodiscitis often present with a confusing clinical picture leading to late diagnosis.

The early use of MRI in the investigation of children with an atypical picture may avoid unnecessary delay in starting treatment and possibly prevent long-term problems. All except one of our children had made a complete clinical recovery at final follow-up. However, all six children in the > 24-month age group showed radiological evidence of degenerative changes which might cause problems in the future.