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Purpose of the study
To establish the relation between the magnitude of the deformity in scoliosis, measured by cobb angle on radiograph & Volumetric asymmetry with the ISIS2 surface topography, and the patient perception of self image and mental health, measured with SRS-22 scores.
Methodology
A total of 89 untreated patients with scoliosis were included in the study. They had clinical assessment, cobb angle measurement of radiograph and surface topography performed on the same day along with SRS-22 questionnaires. The cobb angle was measured by single surgeon using a digital PACS system, who was unaware of the volumetric asymmetry score. Volumetric asymmetry was measured by ISIS2 surface topography performed by a research nurse who was unaware of the cobb angle. Volumetric asymmetry was calculated using standard ISIS2 software. A comparison correlation of SRS scores for function, pain, self image and mental health against cobb angle and volumetric asymmetry was undertaken by clinical scientist. Scores for patient satisfaction to treatment was excluded as these were untreated patients. Statistical analysis was performed using cor. test on software R
Purpose of the study
Monitoring of scoliosis is traditionally done with radiographs which can be associated with an increased risk of cancer secondary to multiple exposures over many years. This study investigates whether lateral asymmetry (LA) from ISIS2 surface topography can predict radiographic cobb angle, to provide an alternative non- invasive means of monitoring scoliosis patients.
Methods
A total of 72 untreated patients with scoliosis (77 curves) with a Cobb angle of 55 degrees or less were included in the study. They had clinical assessment, cobb angle measurement taken from a standard radiograph and surface topography done on the same day. The cobb angle were measured by single surgeon using digital PACS system. The surgeon was unaware of the LA score. Lateral asymmetry was measured using ISIS2 surface topography done by a research nurse who was also unaware of the cobb angle as previously described. Lateral asymmetry was calculated using the standard ISIS2 software. A comparison of cobb angle and LA was performed.
Linear regression analysis was performed to define an equation predicting Cobb from LA. The predicted Cobb angles were then compared with the measured radiographic Cobb angles using Bland-Altman analysis. All statistical analysis was carried out using R.
Introduction
There is no consensus among scoliosis surgeons on which surface topography method and parameters may be used as an alternative to serial radiography to monitor scoliosis progression. The aim of this study was to evaluate the inter-correlation among surface rotation (4-D formetric II) with 3-D Quantec scan and 2-D cobb's angle measurements for assessing torso asymmetry in adolescent idiopathic scoliosis (AIS).
Materials & Methods
A prospective cohort of consecutive 24 patients with adolescent idiopathic scoliosis was accrued from the departmental scoliosis surface topography database. This group comprised of conservatively treated, Spinecor brace treated and postoperative patients in order to assess the wider utility and validity of 2 different surface topography methods (Formetric II & Quantec Spinal Imaging System). Parameters assessed were Q-angle, Suzuki hump sum, Posterior Trunk Symmetry Index (POTSI), surface rotation (rms), surface rotation (max) and maximum Cobb's angle on concurrently done scoliograms.
Objective
To determine if there is a differing effect between two spinal implant systems on sagittal balance and thoracic kyphosis in adolescent idiopathic scoliosis.
Methods
Retrospective analysis of pre and post-operative radiographs to assess sagittal balance, C7-L1 kyphosis angles and metal implant density.
Group 1 (Top loading system): 11 patients (9 females, 2 males) Single surgeon NB
Group 2 (Side loading system): 17 patients (16 females, 1 male) Single surgeon ED
Total 28 patients
All single right sided thoracic curves
Comparison of pre and postoperative sagittal balance and C7-L1 kyphosis angle for each spinal system. Assessment of implant density (i.e. proportion of pedicle screw relative to number of spinal levels involved in correction).
Purpose
This study aims to identify factors that influence the Cobb angle at presentation to a tertiary referral scoliosis centre, and the outcome of the referrals.
Methods
81 consecutive patients referred were reviewed retrospectively. Hospital database, clinic letters and radiographs were examined. Patient demographics, mode of referral (GP vs. tertiary), severity and type of scoliosis were recorded. The season of referral was defined as ‘warm’ between months of June and September, and ‘cold’ between November and March. Cobb angle measurements were made independently on digital radiographs by 2 Orthopaedic trainees.
Purpose
To compare the incidence and nature of ‘neurophysiological events’ identified,
Methods
The IOM wave-recordings, event-logs and reports of all spinal deformity cases conducted by a team of clinical physiologists from April to June 2009 (Group 1) were reviewed retrospectively by the same, experienced clinical neurophysiologist, (MG).
Interventions were then agreed. The first was to alter the IOM report document to drop down menus. The second was to arrange a series of teaching sessions for the clinical physiologists on a variety of aspects of IOM. Finally during these teaching sessions recent cases were brought to review in an informal setting to discuss.
Following implementation of the interventions a further review from April to June 2010 (Group 2) was carried out in the same manner.
The clinical physiologists did not know the time periods over which the review would be taking place.
Study Design
An observational study in patients with congenital spinal deformity.
Objective
To review the relationship between hemivertebrae and the posterior spinal elements in congenital spinal deformity.
Objective
We reviewed the impact of the use of routine perioperative counselling on patients outcomes and experience when undergoing operative deformity correction for adolescent idiopathic scoliosis.
Methods
Between January 2006 and December 2008, 28 consecutive patients underwent operative deformity correction for adolescent idiopathic scoliosis. 26 of these were seen at the initial presentation to clinic by a voluntary counsellor with experience of a family member having undergone scoliosis correction after they had been identified as being likely to require operative intervention. Most patients were only seen once preoperatively by the counsellor but several were seen on multiple occasions. Most patients were offered the opportunity to meet a post-operative patient who had previously had scoliosis correction surgery. SRS 22 questionnaires were completed pre and post-operatively. All curves were classified using the Lenke classification and pre and post operative Cobb angles were recorded. All patients and their parents were followed up at a mean interval of 3 years with a telephone survey regarding how they felt the input from a counsellor impacted on their experience.
Objective
To compare the radiological and clinical outcomes following three different techniques used in the correction of Scheuermann's kyphosis.
Materials and Methods
Twenty three patients with comparable preoperative radiographic and physical variables (age, gender, height, weight, body mass index) underwent correction of thoracic kyphotic deformity using three different surgical methods. Group A (n=8) had combined anterior and posterior fusion with instrumentation using morselised rib graft. Group B (n=7) had combined anterior and posterior fusion with instrumentation using titanium interbody cages. Group C (n=8) had posterior segmental pedicle screw fixation only. All groups had posterior apical multi-level chevron osteotomy and posterior instrumentation extending from T2 to L2/3. Preoperative and postoperative curve morphometry studied on plain radiographs included Cobb angle, sagittal vertical axis (SVA), sacral inclination (SI) and lumbar lordosis (LL). Preoperative and postoperative questionnaires including ODI, VAS and SRS-22 were also analysed.
Background
In the USA more than half the states have legislated scoliosis school screening with the remaining states having either voluntary screening or no recommendations. The four primary care providers for adolescents with idiopathic scoliosis in the USA (AAOS, SRS, POSNA, AAP) do not support any recommendation
Objectives
The purpose of this review was to evaluate the evidence for and against scoliosis screening.
Background
Pleural drains are routinely used following anterior approaches to the spine for the correction of spinal deformities, to prevent the accumulation of blood, fluids and air in the pleural cavity. Following their removal it is routine practise in our Trust to obtain chest radiographs to look out for a pneumothorax or a residual fluid collection. Our hypothesis is that unless clinically indicated the use of a CXR does not affect patient management and should not therefore be routine practice.
Methods
A retrospective audit of 122 consecutive patients, who underwent surgery for the correction of spinal deformity using an anterior approach to the spine, over the course of a year, was undertaken. CXRs were performed in all patients following drain removal. We have reviewed those images and in cases were abnormalities were detected we have examined the case notes to assess the impact of those findings with regards to management.
We describe the results of a prospective case series to evaluate a technique of direct pars repair stabilised with a construct that consists of a pair of pedicle screws connected with a u-shaped modular link that passes beneath the spinous process. Tightening the link to the screws compresses the bone grafted pars defect providing rigid intrasegmental fixation. 20 patients aged between 9 and 21 years with a pars defect at L5 confirmed on computed tomography (CT) were included. The average age of the patients was 13.9 years. The eligible patient had Grade I or less spondylolisthesis and no evidence of intervertebral degeneration on MRI. The average duration of follow-up was 4 years. Clinical assessments for all patients was via the Oswestry disability index (ODI) and visual analogue scores (VAS). At the latest follow-up, 18 of the 20 patients had excellent clinical outcomes with a significant (p<0.001) improvement in their ODI and VAS scores with a mean post-operative ODI score of 8%. Fusion of the pars defect as assessed by CT showed fusion rates of 80%. There were no hardware complications. The strength of the construct obviates the need for post-operative immobilisation.
Introduction
The use of thoracic pedicle screws for the treatment of adolescent idiopathic scoliosis (AIS) has gained widespread popularity. Many techniques has been described to increase the accuracy of free hand placement; however the placement of pedicle screws in the deformed spine poses unique challenges because of possible neurologic and vascular complications. We are describing a universal way of insertion of pedicle thoracic screws which has been applied in many pathologies including the deformed spine.
Methods
Our technique includes exposure of the superior facet of the corresponding body to identify its lateral border border which together with the superior border of the TP denotes our entry point which is just lateral to this crossing, we make a short entry with a straight Lenke probe then continue the track with a strong ball probe to go safely through the cancellous bone of the body. This is retrospective review of radiographs and clinical notes of all the patients who underwent posterior thoracic instrumentation by pedicle screws using the same single technique by one surgeon between June 2008 and December 2009; 1653 screws in 167 consecutive patients (119 females and 48 males). There were 139 deformities, 130 scoliosis (AIS 80, Congenital 31, Neuromuscular 10 and Degenerative 9), 19 kyphosis and 18 other diagnoses (fractures 14, revision 3 and tumour 1).
Objective
The use of all pedicle screw constructs for the management of spinal deformities has gained widespread popularity. However, the placement of pedicle screws in the deformed spine poses unique challenges for the spinal surgeon. The purpose of this study was to evaluate the complications and radiological outcomes of surgery in 124 consecutive patients with spinal deformity. These patients underwent correction of coronal and sagittal imbalance with segmental pedicle screw fixation only.
Background
All pedicle screw constructs have been associated with improved correction in all three planes. In patients with severe deformity, such constructs can obviate the need for anterior surgeries, and the higher implant cost is offset by the avoidance of dual anterior and posterior approaches. Pedicle screw fixation enables enhanced correction of spinal deformities, but the technique is still not widely applied for thoracic deformities for fear of neurological complications. This is a retrospective study that was carried out on 124 patients who underwent segmental screw fixation for coronal and sagittal spinal deformities. The purpose of this study was to evaluate the complications and outcomes of this technique and also assess the evidence of enhanced correction.
Objective
To evaluate functional and oncological outcomes following resection of sacral tumours and discuss the strategies for instrumentation.
Introduction
Primary malignant tumours of the sacrum are rare, arising from bony or neural elements, or bone marrow in haematological malignancies.
Management of such lesions is dictated by anatomy and the behaviour of tumours. Three key issues which arise are the adequacy of tumour resection, mechanical stabilisation and the need for colostomy. Stabilisation is often extensive and can be challenging.
Statement of purpose
We review the current state of development of proton therapy and the implications for beam therapy in the management of primary bone tumours
Introduction
The principle of radiotherapy is to deliver a high dose, accurately, to the tumour. Conventional photon and proton therapy irradiates adjacent tissue significantly. This is reduced with intensity modulation proton therapy (IMPT). This has been demonstrably effective in treating tumours refractory to chemotherapy and conventional radiotherapy such as chrondrosarcomas and chordomas
