There are limited data on scoliosis in cystic fibrosis (CF), and the two most recent studies came to opposite conclusions. Reported prevalence ranges from 2% (within the normal range for the general population) to 15.5%. We felt that a recent study under-estimated the prevalence due to a very young population (mean age 10.9 years), since scoliosis develops most commonly in adolescents. We hypothesised that scoliosis is more prevalent in adolescents with CF compared to the general population. The aim of our study was to determine the incidence of scoliosis in adolescents with CF followed to and beyond skeletal maturity and describe the type of spinal deformity. We included all patients in our CF clinic aged >10 years, and those who have transitioned to adult services in the last 10 years. Patients with a co-existent neuromuscular condition were excluded.

We conducted a retrospective observational study. Most recent chest radiographs at end of spinal growth, or those taken at transition to adult services, were reviewed by a Consultant Radiologist and a Consultant Spine Surgeon. Scoliosis was defined as a Cobb angle of >10° in the coronal plane. Demographics and characteristics of the curves were recorded.

Our cohort included 143 CF patients (48% male) with a mean age at the time of chest radiograph of 18 years (range 15–22 years). 16 (6 male) subjects were noted to have scoliosis with a mean (range) Cobb angle of 14° (10–38°) giving a prevalence of 11%. 13 were single thoracic curves, 2 double and 1 triple. The majority were non-progressive short mid-thoracic curves, convex to the right. 5 curves were progressive, only one of which was significant and required bracing to the end of growth but no surgical treatment.

We found a prevalence of scoliosis in our adolescent CF population that is significantly greater than the general population. Only one curve was significant and progressive requiring bracing, the remainder being minor and non-progressive. A strength of our study is that all patients had achieved skeletal maturity at the time of latest X-ray and, therefore, development or further progression of scoliosis is unlikely. The negative effect of scoliosis on lung function is well-documented. With the progressive nature of CF lung disease, scoliosis may have further deleterious effects. Bone disease is increasingly recognised in CF patients, with osteopenia and osteoporosis occurring earlier and more frequently than in the general population (38% & 24% respectively in 18–32 year old CF patients). To date, studies have failed to show a correlation between scoliosis, lung function and bone mineral density. The paradigm of a radiologically significant (Cobb angle >10°) versus a clinically important scoliosis remains.

Background:

Long-Term Follow-Up Of Lung Function And Quality Of Life (Qol) In Those Undergoing Combined Anterior And Posterior Spinal Fusion (A/Psf) For Ais Is Not Well Documented With Only One Study Extending Beyond 2 Years.

Introduction Zygapophysial joint pain can be treated by RF neurotomy of the medial branch of the dorsal primary rami of the adjacent spinal nerves. The provision of radiofrequency (RF) neurotomy for spinal joint pain has been highlighted as an emerging trend in Australia, Europe and North America. However, there is controversy regarding the efficacy of this procedure. RF neurotomy for spinal pain has been investigated in several experimental and observational studies but these have reported conflicting results.

The purpose of this project was to provide a systematic review of the literature on RF neurotomy for the treatment of spinal pain of zygapophysial joint origin.

Method Electronic database searches, screening of reference lists, hand searching and consultation with experts in the field was undertaken to identify relevant studies. Publications were selected based on predetermined inclusion criteria and the methodological quality of each was rated. Qualitative analysis was performed using the Cochrane Collaboration Back Review Group (CCBRG) levels of evidence (RCTs only) and those used by the National Health and Medical Research Council (NHMRC) (RCTs, observational studies, systematic reviews and guidelines)

Results The search strategy identified 382 potential publications. Of these, 80 studies were selected for review, including 7 RCTs, 52 observational studies, 11 systematic reviews and 10 guidelines. There is conflicting (CCBRG) evidence regarding the efficacy of RF neurotomy for lumbar zygapophysial joint pain. The conclusions of systematic reviews and observational studies are conflicting regarding the efficacy of this procedure for the lumbar spine. In contrast, there is limited (CCBRG) evidence that RF neurotomy is efficacious for neck pain of zygapophysial joint origin in the short term. However, this was reported in one very small RCT which reported only one composite outcome.

Discussion This systematic review found that there is no consistent evidence from either multiple (large) RCTs or systematic reviews that RF neurotomy is efficacious in the treatment of spinal joint pain RCTs need to be conducted with larger sample sizes, (patient) relevant outcomes and adequate assessment of side-effects, which can be serious.

The aim of this study was to determine predictors of persisting moderate/severe pain post orthopaedic injury.

Data were obtained from patients presenting to the two adult level 1 trauma centres in Victoria, Australia between August 2003 and August 2004. The maximum self reported pain levels at discharge and at 6 months post injury were determined using 11-point visual analogue scales (VAS). Moderate/severe pain was defined as a VAS score of 5 or greater. Associations between categorical variables were determined using chi-square tests and adjusted using multivariate logistic regression to determine possible predictors of persistent pain.

Data were obtained from 742 patients (age 15–100 years, 60.7% male). 37.1% had moderate/severe pain 6 months post injury. Moderate/severe pain at discharge was associated with an increased risk (OR 2.46 (95%CI 1.72–3.52), p< 0.0001) and isolated upper extremity injuries were associated with a reduced risk (OR 0.43 (95%CI 0.24–0.75), p=0.003) of moderate/severe pain 6 months post injury. Age (p=0.98), gender (p=0.37) and the presence of multiple orthopaedic (p=0.76) or non-orthopaedic injuries (p=0.58) were not predictors of moderate/severe pain 6 months post injury.

The severity of pain at discharge was the main predictor of moderate/severe pain 6 months following orthopaedic trauma. Further studies are needed to determine if improving pain control prior to discharge can reduce the incidence of persistent pain following orthopaedic injury.

Introduction and Aims: There is a paucity of comprehensive information regarding the management and outcomes of orthopaedic trauma. The aims of this project are to establish a comprehensive registry of orthopaedic injuries, treatments, complications and outcomes based on admissions to Level One Trauma Centres in Victoria.

Method: The Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) has been established through a collaborative project involving Monash University and the Alfred and Royal Melbourne Hospitals. The registry prospectively collects data on all patients with an orthopaedic (bone or soft tissue) injury that are admitted to Victorian Level One Trauma Centres and are managed or followed-up by an orthopaedic unit or have a spinal injury. Data is collected from the patient’s medical record and includes information on demographics, injury diagnosis and treatment methods. Outcomes are measured at discharge and six and 12 months post-injury using patient-oriented measures.

Results: The VOTOR database was established in 2003. This process involved two key stages. The first stage was based on the development of standardised data collection methodology and quality control processes specific to orthopaedic trauma. The second stage involved the commencement of data collection and the administration of outcome measures. From August 18, 2003 until January 12, 2004, 850 participants were registered on the database and there was a greater than 80% response rate for administration of discharge outcome measures. The participants had a median age of 44 (range 16–104) years. There was a greater percentage of male patients (60%) than female patients (40%) and English was the preferred language for most participants (87%). Fortyfive percent of patients were provided with funding from the Transport Accident Commission (TAC). With respect to pre-injury status, the greatest proportion of participants were retired or pensioners (32%), while 14% were tradespersons and 11% had a professional occupation. Most participants achieved an education level of Year 9–11 (32%), followed by 19 percent that reached Year 12.

Conclusion: The VOTOR database provides a unique opportunity to comprehensively examine the nature of orthopaedic trauma. Patient-oriented outcomes associated with these injuries are currently being collected. This research is essential in determining the efficacy of different treatment methods, improving current management options and ultimately reducing the financial and social costs of orthopaedic trauma.