This paper reviews 32 patients (seven boys and 25 girls, mean age 14.5 years) with adolescent idiopathic scoliosis treated by anterior spinal release, fusion and instrumentation from 1989 to 2001. In 22 patients the thoracic curve was involved, in six the thoracolumbar and in four the lumbar curve. The mean preoperative kyphosis (thoracic curves) was 22.3° and the mean Cobb Angle was 56°. Routine exposure through the convexity was performed (sixth rib for thoracic curve and 10th rib for other curves). After discectomy (four to nine levels), morselised rib was used as bone graft and instrumentation was applied with correction of deformity and saggital profile. Costo-plasty was performed in 10 patients. The mean operation time was three hours; mean blood loss was 180 ml. Intraoperative problems were partial pull-out of screws from the first proximal vertebra in three patients. In one asthmatic patient, who was on steroids, instrumentation was abandoned because of pull-out of several screws. The mean hospital stay was 10 days. Two patients developed superficial wound sepsis and one sustained a burn to the right shoulder (cause unknown). Rod breakage occurred in two patients. Angulation at the level below the lowest instrumented vertebra occurred in five patients and was attributed to inappropriate fusion levels. Pseudarthrosis developed in two patients. At final follow-up, the mean Cobb angle was 26° and the mean thoracic kyphosis 30°. The advantages of anterior surgery for idiopathic scoliosis include fewer fusion levels, correction by shortening the spinal column and less blood loss. Difficulty may be encountered in selection of fusion levels and instrumentation of the proximal vertebrae. In cases of very rigid curves, posterior spinal release may improve results

Background: The study evaluates the inter-relationships between Cobb angle (CA), apical vertebral rotation (AVR), apical vertebral translation (AVT) and maximal angle of trunk inclination (max ATI). The effects of sex, curve laterality, curve type and apical levels will be studied. Methods: This is a study of consecutive pre-operative AIS patients. There are 122 pre-operative AIS patients (106 thoracic, 16 thoracolumbar), with a mean age of 15.6 years. From the pre-operative AP radiograph, CA, AVR (Perdriolle) and AVT are measured. The max ATI is measured using the Scoliometer with the patient in a standing forward bending position. Ratios between the measurements are calculated to allow comparison between different curve types and curves at different apical levels. Results: For a given Cobb angle, each of AVR, AVT and max ATI are largest in King type IV curves, less in King type III curves and smallest in King type II curves (p=0.001 to 0.015). For curves without a significant compensatory curve, for a given AVR, the max ATI reduces significantly as the curve apex passes caudally (p=0.002 to 0.019). Sex and curve laterality are not significant factors. Conclusion: It is suggested that as a curve develops, the interaction between the measurements in different planes may be responsible for determining the curve type (presence or absence of a compensatory curve). The smaller surface hump as the curve apex passes caudally is probably due to the transition from fixed ribs to floating ribs to no ribs. These finding also have implications for surgery. In King type IV and III curves, the emphasis should be on correcting translation and derotation perhaps with a primary costoplasty whilst in King type II curves, the emphasis should be on the correct selection of fusion levels and achieving a balanced spine

Aims

To determine whether side-bending films in scoliosis are assessed for adequacy in clinical practice; and to introduce a novel method for doing so.