To determine whether side-bending films in scoliosis are assessed for adequacy in clinical practice; and to introduce a novel method for doing so. Six surgeons and eight radiographers were invited to participate in four online surveys. The generic survey comprised erect and left and right bending radiographs of eight individuals with scoliosis, with an average age of 14.6 years. Respondents were asked to indicate whether each bending film was optimal (adequate) or suboptimal. In the first survey, they were also asked if they currently assessed the adequacy of bending films. A similar second survey was sent out two weeks later, using the same eight cases but in a different order. In the third survey, a guide for assessing bending film adequacy was attached along with the radiographs to introduce the novel T1-45B method, in which the upper endplate of T1 must tilt ≥ 45° from baseline for the study to be considered optimal. A fourth and final survey was subsequently conducted for confirmation.Aims
Methods
Clinical, radiological, and Scoliosis Research
Society-22 questionnaire data were reviewed pre-operatively and
two years post-operatively for patients with thoracolumbar/lumbar
adolescent idiopathic scoliosis treated by posterior spinal fusion
using a unilateral convex segmental pedicle screw technique. A total
of 72 patients were included (67 female, 5 male; mean age at surgery
16.7 years (13 to 23)) and divided into groups: group 1 included
53 patients who underwent fusion between the vertebrae at the limit
of the curve (proximal and distal end vertebrae); group 2 included
19 patients who underwent extension of the fusion distally beyond
the caudal end vertebra. A mean scoliosis correction of 80% (45% to 100%) was achieved.
The mean post-operative lowest instrumented vertebra angle, apical
vertebra translation and trunk shift were less than in previous
studies. A total of five pre-operative radiological parameters differed
significantly between the groups and correlated with the extension
of the fusion distally: the size of the thoracolumbar/lumbar curve,
the lowest instrumented vertebra angle, apical vertebra translation,
the Cobb angle on lumbar convex bending and the size of the compensatory
thoracic curve. Regression analysis allowed an equation incorporating
these parameters to be developed which had a positive predictive
value of 81% in determining whether the lowest instrumented vertebra
should be at the caudal end vertebra or one or two levels more distal.
There were no differences in the Scoliosis Research Society-22 outcome
scores between the two groups (p = 0.17). In conclusion, thoracolumbar/lumbar curves in patients with adolescent
idiopathic scoliosis may be effectively treated by posterior spinal
fusion using a unilateral segmental pedicle screw technique. Five
radiological parameters correlate with the need for distal extension
of the fusion, and an equation incorporating these parameters reliably
informs selection of the lowest instrumented vertebra. Cite this article:
A combined anterior and posterior surgical approach
is generally recommended in the treatment of severe congenital kyphosis,
despite the fact that the anterior vascular supply of the spine
and viscera are at risk during exposure. The aim of this study was
to determine whether the surgical treatment of severe congenital thoracolumbar
kyphosis through a single posterior approach is feasible, safe and
effective. We reviewed the records of ten patients with a mean age of 11.1
years (5.4 to 14.1) who underwent surgery either by pedicle subtraction
osteotomy or by vertebral column resection with instrumented fusion
through a single posterior approach. The mean kyphotic deformity improved from 59.9° (45° to 110°)
pre-operatively to 17.5° (3° to 40°) at a mean follow-up of 47.0
months (29 to 85). Spinal cord monitoring was used in all patients
and there were no complications during surgery. These promising
results indicate the possible advantages of the described technique
over the established procedures. We believe that surgery should
be performed in case of documented progression and before structural
secondary curves develop. Our current strategy after documented
progression is to recommend surgery at the age of five years and
when 90% of the diameter of the spinal canal has already developed. Cite this article:
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
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
