Recently, there is ongoing evidence regarding rapid recovery after orthopaedic surgery, with advantages for the patient relative to post operative pain, complications and functional recovery. The aim of this study is to present our experience in rapid recovery for adolescent idiopathic scoliosis in the last 2 years. Retrospective study of 36 patients with adolescent idiopathic scoliosis, (age range 11 to 18 years) treated with spinal thoraco-lumbar posterior fusion with rapid post-operative recovery, compared with a similar group, treated with traditional protocol. We found a statistically significant difference in terms of length-of-stay, patient-controlled-analgesia and use of oppioid and post operative blood transfusions. There was no difference in post operative infection rate. Our experience shows better functional recovery, satisfactory controlled analgesia and reduction in costs of hospitalization with the use of ERAS protocols

The Cochrane Collaboration has produced five new reviews relevant to bone and joint surgery since the publication of the last Cochrane Corner These reviews are relevant to a wide range of musculoskeletal specialists, and include reviews in Morton’s neuroma, scoliosis, vertebral fractures, carpal tunnel syndrome, and lower limb arthroplasty.

Summary Statement. Patients with adolescent idiopathic scoliosis show clear signs of abnormal motor coordination between the long superficial paraspinal muscles and the deep rotators. These findings suggest an abnormal behavior of the deep rotator muscles at the concave side. Introduction. An imbalance between the myoelectric activity of the muscles of the convexity and the concavity has been described in patients with adolescent idiopathic scoliosis (AIS). These findings are based on EMG patterns recorded with surface electrodes that do not distinguish between deep and superficial muscles. This work was aimed at analyzing the coupled behavior of the superficial and deep paraspinal muscles in subjects with AIS at both sides of the curve. Material. A total of 16 females (mean age, 16.2±4.3 years) with AIS between 20 and 35° Cobb (mean, 32.8±11.9°) underwent electromyography of the paraspinal muscles by direct intramuscular disposable concentric electrodes (Dantec DCN. TM. ) of 25mm and 37mm in length, and 0.46 mm. in diameter. A total of 4 electrodes were inserted at the apex on both sides of the curve (2 in deep rotator muscle and 2 in the long paraspinal superficial muscles). Myoelectrical activity was recorded simultaneously in the four muscle groups in different positions: standing, flexion, extension, right and left lateralizations, and rotations toward the side of the concavity and convexity. A 4-channel Keypoint® electromyography device (Medtronic, Denmark) was used. The recorded signals were analyzed in a laptop with Windows. ®. 7 Intel Core i3 64bit with Matlab. ®. R2012a. The following parameters were analyzed: Signal power, Mean and Median frecuency, and the Dimitrov spectral index, a marker of muscle fatigue. In addition, the signal power in each task was normalised by the signal power in standing position. The records were compared with those obtained in 4 healthy subjects, matched in age, without spinal deformity. Results. The signal amplitude in different subjects and tests ranged from tens of microvolts up to two milivolts. Most of the energy of the EMG signal was concentrated below 500 Hz in power spectrum density chart. In standing position, the activity of the deep muscle was greater than that of the long superficial paraspinal muscles, with higher activation in the convex side (63% of cases). Increased activity of the deep muscles as compared to the surperficial layers was also evident during flexion of the spine, with a higher activity of the deep muscles of the concavity. The 4 muscle groups showed low activity during spine extension movements, though the deep rotator activity was always greater than the superficial paraspinal muscles. In rotation exercises, the most active muscles were found the contralateral with a clear inhibition of the deep muscles of the concavity in the rotation to that side. This did not apply for rotation through the convex side. It was also noticeable that in the case of deep muscles, both sides of the spine require high activation when performing left flexion. Conclusions. Patients with AIS show clear signs of abnormal motor coordination between the superficial paraspinal muscles and the deep rotators. These findings do not clearly define whether this mismatch is primary or secondary to the presence of the deformity although they suggest an abnormal behavior of deep rotator muscles that could have etiopathogenic relevance

Background. After surgical correction of thoracic scoliosis, an improvement in the cardio-respiratory adaptation to exercise would be expected because of the correction of the rib cage associated with the spinal deformity. This work intended to evaluate the physiologic responses to incremental exercise in patients undergoing surgical correction of adolescent idiopathic scoliosis (AIS). The hypothesis of this study was that the exercise limitations described in patients with AIS could be related with the physical deconditioning instead of being linked to the severity of the vertebral deformity. Methods. Cross-sectional study of the exercise tolerance in a series of patients with AIS type Lenke 1A, before and 2 years after surgical correction. Twenty patients with AIS and 10 healthy adolescents aged between 12 and 17 years old were evaluated. The average magnitude of the curves was 60.3±12.9 Cobb. Cardio-respiratory function was assessed before surgery and at 2-year follow-up by maximal exercise tolerance test on treadmill following a Bruce standard protocol. Maximal oxygen uptake (VO2), VCO2, expiratory volume (VE), and VE/VO2 ratio were registered. Results. Before surgery, AIS patients showed lower values than healthy controls in all cardio-respiratory parameters. The most important restrictions were the VO2max in ml/kg/min. (30.3±5.4 vs 49.9±7.5), VE (43.2±10.3 vs 82.3±10.7) and VE/CO2 ratio (25.0±3.9 vs 29.6±4.2). Contrary to expectations, two years after surgery most of these parameters decreased but differences with preoperative data were no statistically significant. Besides the great correction of the deformity (coronal plane, 71.5%; axial rotation, 49.3%), the cardio-respiratory tolerance to the exercise was not modified by surgery. Conclusions. Patients with moderate-severe AIS showed a limited tolerance to maximal exercise that does not change 2 years after surgery. This findings suggests that the reduced cardio-pulmonary function during exercise is not strictly associated to the spinal deformity, since great corrections of the spinal curves does not improve functional ventilatory parameters. In addition, the results point out a severe exercise deconditioning in AIS patients. Level of evidence. Level IV

Background. The improvement of the rib cage deformity (RCD) after surgery correction has not been correlated in detail with the correction of vertebral axial rotation (AR). The loss of at the rib cage after correction has been never monitored. The hypothesis of this work was that the aesthetic improvement of RCD in adolescent idiopathic scoliosis (AIS) does not follow completely the reduction of thoracic AR after correction surgery. Moreover, lesser correction of thorax deformity could be expected in mature patients with more rigid curves. Methods. Multicenter prospective study of the modifications of the rib cage deformity in 24 patients operated because of AIS Lenke type 1A. RDC was assessed in the preoperative MRI exams including the thoracic perimeter. Vertebral AR was quantified by the RaSac angle. Anterior and posterior rib hump, and the translation of the sternum were measured in mm according to standard protocols. All these parameters were assessed in the immediate post-op period and 2-years after surgery using CT-scan axial slides. In all cases, a vertebral derotation technique performed by asymmetric rod bending was used. Immature (Risser 0–2) and mature (Risser 3–4) patients were compared. Results. Mean age of patients was 14±2 years. The preoperative curve magnitude was 56.2±8.3 Cobb degrees. RaSac at the apex was 27.2±2.8 degrees. There were 10 immature and 14 mature patients. There were no differences between the two groups in all the radiological measurements of the curves. Immature patients showed lesser posterior rib hump as compared to mature cases (14.9±4.1 mm versus 38.1±22.9; p<0.001). Postoperative vertebral AR was lesser in immature patients (2.0±1.2 versus 7.9±2.4 degrees) and increased slightly at 2-year check-up. The posterior rib hump showed also a slightly increased 2 years after surgery. In 18 cases (75%), a contralateral anterior rib hump less than 3 mm emerged after surgery that diminished but not disappeared at 2-year check-up. Conclusions. The rib cage deformity showed a lesser correction than the vertebral axial rotation. Besides this finding, immature patients showed more rib cage plasticity showing both greater modifications after surgery, and higher loss of correction during follow-up. Level of evidence. Level IV