Introduction: Sniff nasal inspiratory pressure has become a valuable tool in assessing respiratory muscle weakness. Its role in the scoliosis population is still being defined.

Aim: To assess significance of Sniff nasal inspiratory pressure in paediatric patients with scoliosis. Eighty-nine paediatric patients were investigated with SNIP at the time of preoperative assessment for scoliosis surgery from Jan, 2000 to Dec, 2006. Patients were divided into neuromuscular(24) and idiopathic(55). Other causes and revision were excluded(10). SNIP was evaluated with respect to curve pattern and curve degree. This included radiograph and case note review.

The mean SNIP value for the idiopathic and neuromuscular groups was 70cmH2O and 44cmH2O respectively. This was significantly different (P=0.006). The mean cobb angle for idiopathic pattern was 58°. For the neuromuscular group it was 73°. There was no correlation between SNIP value and curve severity in either the idiopathic or neuromuscular group.

SNIP value does not correlate with cobb angle severity. SNIP can differentiate idiopathic from neuromuscular scoliosis. Low SNIP values are found in neuromuscular scoliosis. Its role in non neuromuscular scoliosis does not appear to be significant.

Background: Sniff nasal inspiratory pressure (SNIP) has become a valuable tool in assessing respiratory muscle weakness. Its role in the scoliosis population is still being defined.

Purpose: To assess significance of Sniff nasal inspiratory pressure value in paediatric patients with scoliosis.

Methods: Eighty-nine paediatric patients were investigated with SNIP at the time of preoperative assessment for scoliosis surgery from Jan, 2000 to Dec, 2006. Patients were divided into neuromuscular (24) and idiopathic (55). Other causes and revision were excluded (10). SNIP was evaluated with respect to curve pattern and curve degree. This included radiograph and case note review.

Results: The mean SNIP value for the idiopathic and neuromuscular groups was 70cmH2O and 44cmH2O respectively. This was statistically significantly different (0.006). The mean cobb angle for idiopathic pattern was 58 degree. For the neuromuscular group it was 73 degree. There was no correlation between SNIP value and curve severity in either the idiopathic or neuromuscular group.

Conclusion: SNIP is a valuable test when used in conjunction with vital capacity and overnight oxygen saturation, height, comorbidities in the neuromuscular population. It is a sensitive indicator of respiratory muscle weakness. It does not appear to reflect increasing curve severity. It does not appear relevant in scoliosis without a neuromuscular disorder.

Significance: SNIP combined with vital capacity, overnight oxygen saturation, height and co morbidities can be used to assess severity of neuromuscular scoliosis. SNIP value alone has little relevance.

Introduction The use of anterior techniques to address scoliosis is well established. The method employed is dependent on the curve type, degree and the institution. There are apparent immediate perioperative advantages of an endoscopic technique over an open thoracotomy. In addition, endoscopic instrumentation and fusion has become accepted as a reliable method to address thoracic scoliosis.

Methods 101 patients have undergone anterior endoscopic instrumented correction for scoliosis at the Mater Children’s Hospital, Brisbane between 2000 and 2005. In 2002, a case series study was established to assess perioperative aspects. The majority of patients were entered into a database prospectively. A total of 83 patients were included in the study at the point of data analysis for this paper. The perioperative factors considered were: Theatre times; Blood management; Mobility; and Complications.

Results The mean age was 16 years. 75 curves were adolescent idiopathic. Eight curves were in neuromuscular patients. The majority, 59 (79%) were Lenke Type 1 curves. Operating times were divided into anaesthetic, surgical and X-ray. There was a mean reduction in anaesthetic time between the first and last 20 cases of 22 minutes (p=0.20). For X-ray this was 73 seconds (p< 0.001). The mean surgical time was 288 minutes. The mean reduction in surgical time was 76 minutes (p< 0.001). A scatter plot was also performed of surgical time versus case number. The surgical time has an apparent plateau after approximately 30 cases. This may suggest a learning curve of this number. The mean intra-operative blood loss was 380mls with no allogenic transfusions. The mean length of stay was 5.8 days. There was an overall perioperative complication rate of 12%. There were six reinsertions of ICC, one conversion to an open thoracotomy, two postoperative chest infections and one patient requiring re-intubation in intensive care due to narcosis. There were no subsequent problems for these patients with perioperative complications.

Discussion The use of endoscopic techniques to address scoliosis is employed in centres specializing in spinal deformity. The results above are comparable to those previously reported for both open and endoscopic anterior techniques. The results outlined demonstrate this to be a safe method regarding the perioperative morbidity and complications associated with the procedure.

Introduction The influence of timing of surgery on functional outcomes following spinal cord injury remains controversial. Animal studies suggest that the rate, degree, and duration of cord compression are the principal determinants of spinal cord injury (SCI) severity and prognosis for recovery. Delamarter et al, (J Bone Joint Surg Am 1995) have shown that when experimental cord compression in dogs is relieved within 1 hour, full motor recovery can be achieved. It is suggested by some clinically based research that definitive surgical treatment for unstable injuries results in fewer sequelae than prolonged immobilization and allows more rapid entry into rehabilitation. It is however the timing of this surgery which remains controversial. It has been suggested that early surgical management promotes neurological recovery by limiting secondary damage caused by inflammation, oedema, ischemia and instability. To date few studies have found a link between neurological recovery and timing of surgery (Fehlings, et al; Spine 2001).

Methods Data was gathered retrospectively by chart review of patients referred to the Princess Alexandra hospital with spinal cord injury. Patients were age matched into high and low velocity groups. This data was studied to assess the effects of energy of injury and timing of surgical intervention on neurological outcome. Patients either had anterior, posterior, or combined surgery, external immobilization or traction depending on the preference of the treating surgeon.

Results A cohort of 43 patients all of whom had spinal cord injury was retrospectively studied. Of these, 21 had a high energy injury (eg. MVA) and 21 had a low energy injury (eg. rugby). 28 had anterior stabilization 7 had traction, 4 had external immobilization 2 had a combined anterior / posterior fixation and 1 had posterior stabilization. The data suggest that the prognosis for recovery following a spinal cord injury is unrelated to the energy involved. The low energy group improved on average 0.6 ASIA grades (SEM 0.16) while the high energy improved 0.7 ASIA grades (SEM 0.17). The timing of definitive intervention for patients with incomplete cord lesions was shown to significantly (p=0.029) effect ultimate functional outcomes. Those with early (within 8hrs) intervention improved an average of 1.4 ASIA grades (SEM 0.21) and those with late intervention improved 0.6 ASIA grades (SEM 0.19). This effect was present in both high and low energy injury groups.

Discussion The timing of definitive intervention for spinal cord injury is still controversial. However there is Class II evidence that early surgery can be done safely in a patient with spinal cord injury (Fehlings, et al; Spine 2001). The findings from this retrospective study suggest that early surgical intervention may improve neurological recovery.