Purpose: The wait for surgical treatment of scoliosis is long in some countries, especially in those with publicly funded health care systems. Long wait times may have serious consequences if the deformity increases during the wait period. This study was undertaken to determine the surgeon’s perspective of the type and magnitude of surgery required with specific emphasis on peri – and post-operative measures, for patients with scoliosis on prolonged waitlist times (> 6 months) for surgery.

Method: Radiographs from 11 patients who had a Cobb angle of at least 50 degrees and had waited 6 or more months for scoliosis surgery selected from the scoliosis database. All patients had antero-posterior (AP), AP bending, and lateral radiographs taken when the primary curve magnitude was 50 degrees and at the time of pre-operative planning. 22 radiographic sets and a questionnaire were sent to three different surgeons. The surgeons were blinded to the fact that these sets contained films of the same patients at two different time points. The questionnaire requested information with regard to the type of surgery and instrumentation they would use, other peri-operative measures, and time taken to return to normal activities.

Results: The mean curve progression in the 11 patients was 25 degrees over the time on the waitlist, from an average of 50 degrees to 75 degrees. The type of surgery the surgeon would likely perform changed from posterior instrumentation and fusion with a screw construct in all patients to anterior release and posterior instrumentation and fusion with a screw construct in 8 of the 11 patients, in at least one surgeon’s opinion. The mean estimated operative time increased by 2 hours. The mean estimated length of stay at the hospital increased by 1 day, and the estimated level of difficulty of surgery increased from 3/10 to 5/10.

Conclusion: From a surgeon’s perspective, waits of 6 months or more for scoliosis surgery are unacceptable as they lead to the need for a second anterior procedure that probably would have not been necessary had the operation occurred earlier. It also leads to increased operative time, blood loss, length of stay, and difficulty of surgery. This, in turn, increases unwarranted risks and costs.

Purpose: There is scant literature with respect to reproducibility in radiological measurements of vertebral morphology. The purpose was to determine the reliability of measurement of various parameters of vertebral morphology in idiopathic scoliosis.

Method: Ten patients with AIS were investigated with standardised low dose multi-slice helical CT. Axial reconstructions in the plane of the T8 (apical) vertebra were performed prone, as per Jamieson et al (2008). Antero-posterior (AP) canal diameter, left and right pedicle width, canal width, left and right mid-point to medial pedicle length, left and right pedicle length, and cord length, left and right transverse angles, and left and right canal area were measured by our spine surgeons and spine surgery fellow. Statistical analysis for intra-class coefficients (ICC) for intra and inter observer reliability was then performed.

Results: Intra-observer reliability was excellent, with a mean ICC score of 0.930 (range 0.608–0.996), across all fourteen variables. Inter-observer reliability was very good with a mean ICC score of 0.890 (range 0.360–0.987), across all variables. There was poor inter-observer reliability for measurement of the transverse pedicle angles (0.360 – 0.446). The intra-observer reliability for transverse pedicle angles, whilst good (0.608–0.861), was worse than any of the other intra-observer reliabilities.

Conclusion: We demonstrate excellent intra, and inter observer reliability for measurement of apical vertebrae morphology in AIS. This tool can be utilized in the further study of pedicle dysplasia. Measurement of transverse pedicle angle was less reliable than any of the other measurement variables. A standardised measurement of the morphology of vertebral canal, pedicles and vertebral body morphology is reliable both within individual observers, and across a group of observers. A standardised measure for further investigation has been validated which will enable study of the evolution of pedicle dysplasia over time. This will lead to a better understanding of the etiology of pedicle dysplasia in scoliosis.

Purpose: The lateral pillar classification for Perthes disease described by Herring in 1992 has gained wide acceptance as a method of predicting outcome and planning treatment. Our purpose was to determine the reproducibility of Herring’s lateral pillar classification using visual estimation and by direct measurement and determine if the Herring’s grading alters as the child passes through the stage of fragmentation in Perthes’ disease.

Method: One hundred AP and frog lateral radiographs of children with unilateral Perthes’ disease in the stage of fragmentation were classified according to the Herrings classification by two investigators utilizing a visual and measurement technique. The change in Herring’s grading with progression of disease was evaluated in 86 patients with sequential radiographs in the stage of fragmentation.

Results: The level of intra-observer agreement by the measurement technique was excellent for both AP and lateral radiographs (Kappa = 0.92 and 0.98) as compared to the visual method for which the agreement was moderate (Kappa = 0.65 and 0.5). The inter-observer reproducibility was moderate by the visual method for both AP and lateral radiographs (Kappa = 0.51 and 0.43). The level of agreement for the measurement method was good for the AP radiographs (Kappa = 0.66) and was only moderate for the frog lateral radiographs (Kappa = 0.53). Of the total 86 cases that had sequential radiographs in the stage of fragmentation, 33 showed change in Herring’s grading. Among these 33 cases, 25 showed a change in the extent of epiphyseal collapse in the AP radiographs alone whereas 8 cases showed a change in lateral radiographs. Upgrading of Herring’s grade from A to B was seen in 11 cases and from B to C in 14 cases as observed in the AP radiographs. The clinical variables and radiological variables did not show any association with progression of Herring’s grade.

Conclusion: The measurement technique of assessing Herring’s classification is much more reliable than the originally described visual method. However, the Herring’s grade changes with the evolution of the disease even during the process of fragmentation and must be used with caution when predicting prognosis.