Audit is an important part of surgical practice. Commissioners may use it as evidence of quality assurance. No comprehensive audit exists in spinal surgery. Usage of existing databases is disappointing. We developed an audit database which was comprehensive and gathered patient outcomes. The underlying principles were:

All patients having surgery should enter,

Demographic data, OPCS codes, length of stay and other data were downloaded directly from the hospital information systems. A monthly printout of patients enrolled was provided to the audit coordinator. She was responsible for the collection of clinical outcomes at 6 months, 12 months, and 2 years after surgery. The initial audit involved the Northwest and Mersey Regions. Data from the hospital information systems (HIS) for two years were available for comparison. Unfortunately only two centres gathered clinical outcomes. We have continued to gather data. 380 patients have been enrolled. HIS data are available for all. With varying lengths of follow up, there are 1045 potential clinical outcomes available. Only 8 patients (2%; 8 outcomes, 0.76%) have been lost to follow up. Using this data we are able to compare outcomes between surgeons, between surgical procedures, and see changes over time. As far as we know we are the only centre in the UK able to do this. It is a valuable Clinical Governance tool. We believe that the principles underlying this audit are the only means to obtain comprehensive outcome audit in surgery.

We studied 70 consecutive patients with adolescent idiopathic scoliosis who underwent corrective surgery. They were divided into two groups. In the study group of 38 patients one or more modern blood-conservation measures was used peri-operatively. The 32 patients in the control group did not have these measures. Both groups were similar in regard to age, body-weight, the number of levels fused and the type of surgery.

Only two patients in the study group were transfused with homologous blood and these transfusions were ‘off-protocol’. Wastage of autologous pre-donated units was minimal (6 of 83 units). By contrast, all patients in the control group were transfused with homologous blood. In the study group there was a significant decrease (p = 0.005) in the estimated blood loss when all the blood-conservation methods were used.

The use of blood-conservation measures, the lowering of the haemoglobin trigger for transfusion and the education of the entire team involved in the care of the patient can prevent the need for homologous blood transfusion in patients undergoing surgery for adolescent idiopathic scoliosis.

Objectives: 1. To assess the results of early intervention in patients with infantile idiopathic scoliosis. 2. To determine prognostic factors

Design: Retrospective cohort study

Subjects: 16 consecutive patients with infantile idiopathic scoliosis who have completed a serial casting programme

Outcome measures: Curve progression, rib asymmetry and the occurrence of surgery

Results Of 16 patients 6 were male, 5 had plagiocephaly and there were 9 left sided curves. The size of the curve of all except one patient improved by casting – 4 curves resolved completely and a further 4 improved by more than 50%. Sex, the presence of plagiocephaly and the size of the curve did not influence outcome. Rib asymmetry was a negative prognostic sign. Early treatment was associated with a significantly better outcome. One child has had surgical treatment.

Conclusions Most children with infantile idiopathic scoliosis can be improved by serial casting.

Rib asymmetry is confirmed as a negative prognostic sign. Early treatment gives better results.

Objective: This study evaluates the use of the Isola Growing Rod System for scoliosis in a group of skeletally immature patients with predominantly neuromuscular disorders. Our series of patients was unsuitable for definitive anterior and posterior fusion due to poor respiratory function.

Design: We reviewed the case notes and x-rays of eighteen patients who had undergone instrumentation with the Isola Growing Rod System. The Cobb angles on the pre-operative and subsequent post-operative X-rays were measured. Complications were noted.

Subjects: Eighteen children with scoliosis.

Outcome measures: Curve correction and complications.

Results: Two patients had idiopathic scoliosis, four patients had spinal muscular atrophy with the remainder having varied diagnoses. Eight patients were fully ambulant, the remainder being wheelchair bound pre-operatively. The average age at rod insertion was eight years, three months. The average number of lengthenings was four. The mean pre-operative Cobb angle was 76 degrees, the mean most recent Cobb angle 28 degrees. One patient required definitive fusion. Two patients required revision procedures due to implant failure.

Conclusion: Our study shows that progressive scoliosis associated with neuromuscular disorder can be controlled with the growing rod system, thus avoiding both anterior release and the ‘crankshaft’ phenomenon, until the optimal time for definitive spinal fusion.

Bone-marrow transplantation has increased the survival of patients with mucopolysaccharidosis-I. We describe the spinal problems and their management in 12 patients with this disorder who have been followed up for a mean of 4.5 years since transplantation.

High lumbar kyphosis was seen in ten patients which was associated with thoracic scoliosis in one. Isolated thoracic scoliosis was seen in another. One patient did not have any significant problems in the thoracic or lumbar spine but had odontoid hypoplasia, which was also seen in three other children. Four of the eight patients in whom MRI of the cervical spine had been performed had abnormal soft tissue around the tip of the odontoid.

Neurological problems were seen in two patients. In one it was caused by cord compression in the lower dorsal spine 9.5 years after posterior spinal fusion for progressive kyphosis, and in the other by angular kyphosis with thecal indentation in the high thoracic spine associated with symptoms of spinal claudication.