Introduction Chicken studies implicate pinealectomy within a week of hatching as a cause of scoliosis. The nature of the scoliosis has been demonstrated to be similar to that of human idiopathic scoliosis. Scoliosis was not induced following pinealectomy in Rhesus monkeys (primate model). No human studies have been reported. The aim of this study is to determine if idiopathic scoliosis is associated with treatment for pineal lesions (presumably resulting in pinealectomy) in a human paediatric population.

Methods A medical records search was performed in five Australian States for pineal lesions. Identified patients underwent clinical or radiological evaluation for scoliosis. Pathology varied from germ cell tumour, germinoma, pineoblastoma, teratoma to a pineal cyst and an epidermoid cyst. Treatment ranged from biopsy/ extirpation to radiotherapy/chemotherapy.

Results Of 48 identified patients, thirteen are deceased. No scoliosis was present in the last imaging of the deceased. The mean age at presentation was 9.7 years (range 1–18 years). Ten are female. Two males have idiopathic scoliosis (4.2%). One has a 12° right upper thoracic curve (with 32° kyphosis) and the other has a 60° right thoracolumbar curve, requiring a two-stage arthrodesis

Discussion Although the incidence of idiopathic scoliosis in this cohort is greater than expected from Caucasian population studies (2–3%), it is not typical idiopathic-type, which has a female preponderance of larger deformities. New-born chicken studies demonstrate an incidence of between 50 and 100% scoliosis in the three months following pinealectomy. Chickens of both sexes are involved. Fundamental differences exist between chicken and human/primate models including the age at pinealectomy and the anatomical site of the pineal gland. Chickens have a naturally lordotic thoracic spinal curvature whilst humans/primates have a naturally kyphotic thoracic spine. Adolescents with idiopathic scoliosis have either thoracic hypokyphosis or a thoracic lordosis. Contrary to current beliefs, no causal link can be established between pineal lesions and the development of idiopathic scoliosis in a paediatric population.

Introduction Delayed puberty and delayed skeletal maturation have been implicated as risk factors for the progression of idiopathic scoliosis. Genetic defects (Turner syndrome) and hypothalamic- pituitary disorders are known causes of delayed puberty. Although it is recognized that the incidence of idiopathic scoliosis is elevated in Turner syndrome, human studies regarding the incidence/severity of scoliosis in children with suprasellar, hypothalamic region and pituitary tumours/ disorders is deficient.

Methods A medical records search in five Australian states for suprasellar, hypothalamic region and pituitary tumours/disorders was performed. Identified patients underwent clinical or radiological evaluation for scoliosis. Pathology varied from suprasellar-hypothalamic region tumours, pan-hypopituitarism, pituitary tumours and growth hormone deficiency as well as a craniopharyngioma, arachnoid cyst, retinoblastoma and encephalocele.

Results Of 23 identified patients, ten are female. Mean age at presentation was 8.4 years. Three have right thoracic scoliosis with a Cobb angle less than 20 degrees. Two are males; one with pituitary hormone deficiency and the other with Cushing’s disease treated with radiotherapy. The only female is on a growth hormone treatment program for idiopathic growth hormone deficiency.

Discussion The only female with scoliosis was 12 years old. Delayed puberty could not be linked to either male with scoliosis. Although the incidence of idiopathic scoliosis in this cohort is greater than expected from Caucasian population studies (2–3%), the male preponderance is unusual. No relationship between delayed skeletal maturation and idiopathic scoliosis could be established.

Lumbosacral dislocation injuries are rare. Severe trauma disrupts the mechanically stable lumbosacral junction, rendering the injuries particularly unstable. Aggressive surgical management has been recommended. We present a review of our experience with these uncommon injuries defining injury patterns, surgical strategies and outcomes.

Six patients were treated at Auckland Hospital in the last decade. Thorough review and literature search were performed to revise recommendations for management. All injuries were associated with high-energy trauma. In two cases there was evidence of previous spondylolysis, with dramatic progression after injury. All cases were surgically treated with decompression, reduction as indicated, and fusion with instrumentation. The only instrumentation failure occurred when reduction reconstituted disc height without attention to reconstruction of the severely mechanically compromised intervertebral disc. Satisfactory recovery of nerve root injury occurred in all but one case. Major cauda equina damage did not occur. Correlations with previously described classification systems for this injury were poor, and often showed injuries to span grades. These highly unstable injuries require a high index of suspicion, and aggressive surgical management of these highly unstable injuries is warranted, yielding satisfactory outcomes.

Existing classification systems are of little value prognostically, or in planning treatment, and it is better to classify and treat these injuries specifically relating to the anatomical injury patterns. The severe disruption to the intervertebral disc warrants special consideration with attention to a stable reduction position or three-column reconstruction. Spondylolysis may represent a predisposing factor.

PURPOSE: Lumbosacral dislocation injuries are rare. Severe trauma disrupts the mechanically stable lumbosacral junction, rendering the injuries particularly unstable. Aggressive surgical management has been recommended. We present a review of our experience with these uncommon injuries defining injury patterns, surgical strategies and outcomes.

METHODOLOGY: Six patients were treated at Auckland Hospital in the last decade. Thorough review and literature search were performed to revise recommendations for management.

RESULTS: All injuries were associated with high-energy trauma. In two cases there was evidence of previous spondylolysis, with dramatic progression after injury. All cases were surgically treated with decompression, reduction as indicated, and fusion with instrumentation. The only instrumentation failure occurred when reduction reconstituted disc height without attention to reconstruction of the severely mechanically compromised intervertebral disc. Satisfactory recovery of nerve root injury occurred in all but one case. Major cauda equina damage did not occur. Correlations with previously described classification systems for this injury were poor, and often showed injuries to span grades.

CONCLUSIONS: These highly unstable injuries require a high index of suspicion, and aggressive surgical management of these highly unstable injuries is warranted, yielding satisfactory outcomes. Existing classification systems are of little value prognostically, or in planning treatment, and it is better to classify and treat these injuries specifically relating to the anatomical injury patterns. The severe disruption to the intervertebral disc warrants special consideration with attention to a stable reduction position or three-column reconstruction. Spondylolysis may represent a predisposing factor.

Introduction: Ultra high molecular weight polyethylene (UHMWPE) wear debris generated at the articulating interface of total hip arthroplasties continues to be the major cause of early failure of these implants.

Aim: To validate the accuracy and reproducibility of the three-dimensional technique (3D) of in vivo measurement of UHMWPE wear using PolyWare ™ when applied to digitised radiographs. The aim was to keep the cumulative errors below the accepted annual linear wear rate of 0.15 mm.

Method: Using precision phantoms with known cup and head sizes and known deviation simulating wear, series of x-rays were taken simulating a number of variables. These variables were grouped into: patient variables (centering, exposure, motion artefact, prosthesis orientation), image acquisition variables (film and cassette type, x-ray exposure, non-circularity of the projected image, magnification, image sharpness), digitisation variables (input resolution, sharpness), and errors inherent to the PolyWare™ software analytical process.

Results: Patient factors contributed the largest errors to the process – these were highly variable. Exposure and input resolution also contributed errors to a lesser extent. No significant error introduction was found with regard to any of the other above-mentioned factors, in particular the PolyWare™ analysis.

Conclusions: The three dimensional method (PolyWare™) is accurate and highly reproducible. Apart from patient factors, which directly and indirectly introduce errors, this method is a satisfactory means of estimating the in vivo wear of UHMWPE.