Aim: The aim of this study is to prospectively evaluate the functional outcome of surgical correction in 20 patients with a significant neuromuscular scoliosis.

Method and Results: The principal objective of surgical correction of neuromuscular spinal deformity should be to maintain or improve function of the patient, but there is little evidence to support this. In wheelchair dependent patients the goal is also to maintain sitting ability, and in ambulant patients prevention of further deformity is important. Studies formally quantifying these outcome parameters have not been published with modern surgical techniques.

A consecutive series of 20 children with neuromuscu-lar scoliosis (age range 2–18 years) undergoing surgical correction were evaluated using 2 standard functional assessment tools, the Seated Postural Control Measure (SPCM) which assesses posture and function, and the Pediatric Evaluation of Disability Inventory (PEDI) which records functional ability in the domains of self-care, mobility and social function. The patients were evaluated pre-operatively and then at 2 weeks, 3 and 12 months post-operatively.

Complete data is presented for all patients at 3 months and 13 of 20 patients at 1 year follow up, the remaining data is to be collected.

The SPCM demonstrated an improvement in posture in 95% from pre-op to 2 weeks post-op, with 25% demonstrating some regression at 3 months. Most maintained or improved this at 1 year. The PEDI demonstrated a reduction in mobility at 3 months but at 1 year 60% returned to preop status.

Conclusion: Sitting position is improved by surgery, but mobility is impaired for a significant period following the correction, which may have more impact on the child’s and families life. Families need to be counselled prior to surgery about the loss of mobility and ability to self-care post operatively but that it does return by one year.

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.

Objective: To assess if a minithoracotomy gives sufficient access to undertake satisfactory anterior release and fusion of the thoracic spine.

Design: A prospective collection of data in patients undergoing anterior spinal surgery.

Subjects and Methods: Ten patients, nine with adolescent idiopathic scoliosis (AIS) and one with congenital thoracolumbar kyphosis underwent anterior release and fusion through a minithoracotomy. A minithoracotomy being defined as a thoracotomy through an incision of ≤ 6cm. The female to male ratio was 3: 2 with an average age at the time of surgery of 13.5 years (10–15) in the scoliosis group. The patient with congenital kyphosis was operated on at 24 years of age. The mean standing pre-operative Cobb’s angle in the AIS group was 78.4° (60–110°), and this was reduced to a mean of 64° (45–85°) on bending films, with a flexibility of 18.4% (2.7–40%). The pre-operative kyphosis angle in the kyphosis patient was 60°. The thoracotomy incisions were measured with a sterile measuring tape on the completion of closure.

Results: All anterior surgery was satisfactorily achieved through a minithoracotomy with mean incision length of 6.5 cm (5.5–7). The average time taken for thoracotomy and procedure was 99 minutes (40–120) and an estimated blood loss of 116mls (50–250). Satisfactory correction was achieved in all patients with the mean improvement of the Cobb’s angle of 56% and post-operative Cobb’s angle of 34° (18–52). The post-operative kyphosis angle in the thoracolumbar kyphosis patient was 45°. The mean post-operative stay in the intensive care unit was 1.2 days (1–2); the duration of chest drain 1.5 days (1–2); blood transfusion requirement 2.9 units (1–6) and the post-operative stay on the ward 7 days (6–8). Two complications were seen comprising of minor chest infection and superficial infection of the chest drain wound requiring a course of oral antibiotics.

Conclusion: A minithoracotomy provides satisfactory access to achieve anterior release as demonstrated by satisfactory correction achieved with improved cosmesis, acceptable operation time and blood loss and with minimal complications.