Aim

Megaprosthesis have become a standard option in limb preserving surgery after bone resection in musculoskeletal tumors. Recently they have also been used in complex revision arthroplasty in cases with massive bone loss. The aim of this study was to analyze the incidence of periprosthetic joint infection (PJI) both in primary oncology cases and aseptic revision cases and analyze which are the significant risk factors for PJI with a special interest on the use of prophylactic antibiotic loaded calcium sulfate beads

The standard approach of diagnosing and monitoring scoliosis involves using the Cobb angle from posteroanterior (PA) radiograph. This approach has two key limitations: 1) It involves exposing the patients to ionising radiation during a period of heightened radiosensitivity. 2) The 2D x-ray image is a projection image of a 3D deformity and the Cobb angle represents only lateral rotation. 3DUS would overcome both these limitations.

We developed a 3DUS system by combining motion capture technology, a conventional 2D ultrasound scanner and bespoke software. An ex vivo experiment and a pilot clinical study were carried out to demonstrate the system's ability in identifying vertebrae landmarks and quantifying the curvature. For the ex vivo validation, a spine phantom was created by 3D-printing a segmented abdo-pelvis CT scan. The spine phantom was then scanned using 3DUS and the level of agreement in the dimensions measured using 3DUS and CT was assessed. An 11 year old female with adolescent idiopathic scoliosis (AIS) was scanned with 3DUS. The SP co-ordinates were projected on a plane of best-fit to compare the curvature angle from 3DUS with the Cobb angle from the x-ray image.

The spinous (SP), transverse processes and the laminae demonstrated high echogenicity and were easily identifiable. The difference between the spine phantom inter-SP dimension measurements made in 3DUS and CT was <2.5%. The PA x-ray of the AIS patient revealed 47° (L4-T11) and 52° (T6-T11) curves. 3DUS was able to represent the deformity in 3D revealing complex curvatures in all planes. The curvature angle from derived from 3DUS for the L4-T11 and T6-T11 curves were 132° (48°) and 125° (55°) respectively.

The results of this pilot study demonstrate 3DUS as a promising tool for imaging spine curvature

Aims:

Identifying and scoring risk factors that predict early wound dehiscence and progression to metalwork infection. Results of wound healing, eradication of infection and union of with the use of vacuum dressing. Compare results of serial washouts against early vacuum dressing in this group of children with significant medical co-morbidities.

Introduction

The correction of paediatric scoliosis is a surgical procedure in which substantial bleeding occurs, and which historically has been associated with high levels of blood transfusion. Transfusions are associated with risks of infection, allergic reactions, volume overload and immunosuppression.

The purpose of our study was to evaluate the efficacy of a care pathway implemented at St Thomas' hospital over ten years with a focus on minimising the need for blood transfusions. A Spinal Surgery Care Pathway was developed including: nurse-led clinics facilitating pre-operative haemoglobin optimisation; intra operative cell-salvage, the use of tranexamic acid, and a transfusion criteria awareness programme.

Introduction: Pedicle screws are now commonly used to instrument the thoracic spine and offers improved three point fixation and therefore theoretically offers better derotation of the spine during corrective manoeuvres in scoliosis surgery.

Aim: To compare thoracic scoliosis correction using either pedicle hooks or pedicle screws.

Methods: Two patient groups were studied. Data was collected prospectively and this is a review of the radiological data. All patients had structural thoracic scoliosis. Group 1, 14 patients (9 female and 5 male) mean age 14.6, were treated with posterior correction of scoliosis using the standard USS II technique using pedicle hooks and screws. Group 2, 14 patients (11 female and 3 male) mean age 15.3 were treated using pedicle screws alone to correct the apical deformity, using a variation of the original USS technique. Pre and postoperative Cobb angle, apical vertebral rotation (AVR, Perdriolle method) and apical vertebral translation (AVT) were measured. Unpaired “t” test was used to compare the magnitude of correction in both groups. The mean follow up period was 30 months (range: 27–42).

Results: The mean corrections of Cobb angle, AVR and AVT, in group I were 61.1% (range: 48.5–83.9), 33.3% (range: 8.6–100) and 62.9% (range: 43.2–91.4), respectively. In Group 2 the corrections were: 57.4% (range: 21.4–81.7), 57.2% (range:16.7–100) and 58.7% (range: 34–80.9). There were no statistically significant differences between the correction of Cobb angle or AVT in both groups (P=0.479 and 0.443 respectively). However, the pedicle screws proved to be more effective at correcting the AVR (P= 0.017). No complications occurred and correction has been well maintained with a minimum of 2 year follow-up.

Conclusion: Pedicle screws can safely and effectively replace the pedicle hooks in the classical USS technique. They are more effective at correcting the rotational deformity, although do not provide a better correction of Cobb angle. These technical results now need to be correlated with relevant clinical outcomes.

Introduction: MRSA spondylodiscitis is an increasingly common phenomenon. Despite this there is very little reported on it.

Objectives: Our objective was to present relevant demographics, clinical presentations and outcomes for this condition from our institution.

Methods: We performed a retrospective review of patients presenting over a six year period from 2000 to 2005.

Results: 13 cases were identified. The mean age was 65 years (range 36–92), 85% were male. All cases presented with back pain, spinal tenderness and systemic upset. Neurological deficit was present initially in 38% and a further 8% developed neurological deterioration during treatment. The thoracic spine (53%) was most commonly affected followed by the lumbar (33%), thoracolumbar junction (7%) and cervical spine (7%); 16% of cases were multilevel. The WCC, ESR and CRP were elevated in all cases with means of 17.3 ×10-9/L, 102 mm/hr and 236 mg/L respectively. In cases cured of infection, the WCC, ESR and CRP normalised at a mean of 10 weeks, 14 weeks and 19 weeks respectively. Radiological diagnosis was established with MRI in all cases. The most common risk factors were diabetes mellitus (62%), mal-nourishment (54%), cirrhosis (31%), end stage renal failure (15%) and intravenous drug use (15%). Multiple risk factors were present in 76% of cases and 15% had no identifiable risk factors. The main sources of sepsis were intravenous catheters (23%), urinary tract (15%) and intravenous drug use (15%). In cases cured of infection treatment consisted of intravenous vancomycin mono-therapy for a mean period of four weeks followed by oral combination or monotherapy antimicrobials for a mean period of 8 weeks. Operative intervention was required in 38% of cases. At six months 54% of cases were clinically free of infection, 38% had died and 8% required ongoing treatment. Neurological deficit was present in 50% of survivors. At one year 29% of survivors suffered from MRSA bacteraemia and spondylodiscitis recurrence.

Conclusion: This is a devastating condition. Clinical suspicion should remain high and prompt diagnosis and treatment is essential.

Aim: To compare thoracic scoliosis correction using either pedicle hooks or pedicle screws.

Methods and results: Two patient groups were studied. Data was collected prospectively and this is a review of the radiological data. All patients had structural thoracic scoliosis. Group 1, 14 patients (9 female and 5 male) mean age 14.6, were treated with posterior correction of scoliosis using the standard USS II technique using pedicle hooks and screws. Group 2, 14 patients (11 female and 3 male) mean age 15.3 were treated using pedicle screws alone to correct the apical deformity, using a variation of the original USS technique. Pre and postoperative Cobb angle, apical vertebral rotation (AVR, Perdriolle method) and apical vertebral translation (AVT) were measured.

Unpaired “t” test was used to compare the magnitude of correction in both groups. The mean follow up period was 6.7 months (range:3–18).

The mean corrections of Cobb angle, AVR and AVT, in group I were 61.1% (range:48.5–83.9), 33.3% (range:8.6–100) and 62.9% (range:43.2–91.4), respectively. In Group 2 the corrections were: 57.4% (range:21.4–81.7), 57.2% (range:16.7–100) and 58.7% (range:34–80.9).

There is no statistically significant difference between the correction of Cobb angle or AVT in both groups (P=0.479 and 0.443 respectively). However, the pedicle screws proved to be more effective at correcting the AVR (P= 0.017). No complications occurred and correction has been well maintained.

Conclusion: Pedicle screws can safely and effectively replace the pedicle hooks in the classical USS technique. They are more effective at correcting the rotational deformity, although do not provide a better correction of Cobb angle. These technical results now need to be correlated with relevant clinical outcomes.