STUDY DESIGN A study was done to evaluate the use of voluntary supine side bending radiographs and Risser table traction radiographs in adolescent patients undergoing posterior spinal fusion for idiopathic scoliosis. OBJECTIVES To compare the usefulness of supine side bending and traction radiographs in assessing curve flexibility and determining fusion levels in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA Supine side bending radiographs have been used in the preoperative evaluation of idiopathic scoliosis to determine curve flexibility and fusion area. Traction films have been used to determine the flexibility of large curves and neuromuscular curves where active side bending is not possible. No study to date has compared the use of these films in patients with adolescent idiopathic scoliosis undergoing surgery. METHODS Seventy-five patients with more than a 2-year follow-up period after surgery were included in this study. Preoperative radiographs included a standing posteroanterior and lateral film and both supine maximal voluntary side bending films and a traction film done on a Risser table. A preoperative review of these radiographs was done to determine curve flexibility and fusion levels. At follow-up evaluation, the patients were examined for any evidence of decompensation or "adding-on" of levels. RESULTS For curves less than 60 degrees, side bending radiographs showed greater curve correction than traction radiographs, whereas the opposite was true for curves greater than 60 degrees. For King I and II curves, side bending radiographs were superior for determination of lumbar curve flexibility and for distinguishing these two types of curves. On traction radiographs, the stable vertebra was 1.4 vertebral levels higher than on the standing film. When the fusion level was moved proximally because of the traction radiograph, decompensation or "adding-on" commonly occurred. CONCLUSIONS Supine bending radiographs are superior to traction radiographs for assessing curve flexibility except for curves more than 60 degrees. The selection of the distal extent of fusion based on the traction radiograph gave a large number of poor results. The selection of fusion levels in adolescent Idiopathic scoliosis is best determined by a combination of standing posteroanterior and lateral radiographs and the supine maximum voluntary bend films.

Comparison of the use of supine bending and traction radiographs in the selection of the fusion area in adolescent idiopathic scoliosis

Background
The prognosis of patients with metastatic osteosarcoma remains poor. However, the chance of survival can be improved by surgical resection of all metastases. In this study we investigate the value of serum alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) in predicting the presence of metastatic disease at time of diagnosis.

Pre-treatment serum lactate dehydrogenase and alkaline phosphatase as predictors of metastases in extremity osteosarcoma.

The most prevalent primary malignant bone tumor affecting children and adolescents is osteosarcoma. Osteosarcoma is characterized by the formation of immature bone or osteoid tissue by neoplastic cells. They arise predominantly in the long bones, occasionally in the axial bones, and seldom in the soft tissues. Patients with osteosarcoma are currently treated with preoperative (neoadjuvant) chemotherapy followed by tumor resection, and further postoperative chemotherapy. Wide margin resection often is necessary and leave large bone defects. These defective bones must be reconstructed and repaired using appropriate materials and methods to restore function and structure. Currently, autograft, allograft, prosthetic implant, or a combination is used for defect reconstruction. Despite the available options, reconstruction of large bone defects and improvement in survival rates are still challenging. Tissue engineering and regenerative medicine (TERM) may be promising alternative strategies to regenerate bone and may change conventional treatment strategies in patients with osteosarcoma. TERM in the form of scaffolds, healing promotive factors, or stem cells could be designed to be useful for bone reconstruction and regeneration and also for delivery of anti-cancer therapeutic agents. Combining TERM approaches with immunotherapy, chemoimmunotherapy, radioimmunotherapy, and gene therapy together with advances in diagnostic procedures may change palliative results to curative achievements in the future. This review comprehensively discusses current options, challenges, possible strategies, and future directions in managing patients with osteosarcoma.

http://www.researchgate.net/profile/Soodeh_Alidadi/publication/271510327_Osteosarcoma_Current_concepts_challenges_and_future_directions/links/553a2b0c0cf245bdd7624e1b.pdf

Osteosarcoma: Current concepts, challenges and future directions

Various factors affect the development of the vertebral canal. The dimensions of the vertebral canal and the intervertebral foramen can be altered by these factors before or after birth. Sex differences in dimensions have also been reported. When there is a stenosis of the vertebral canal or the intervertebral foramen, neural structures confined within them can be affected easily, resulting in symptoms. Using computed tomography images, we compared vertebral canal dimensions in 100 patients with low back pain and/or radiculopathy with those in 40 healthy, non-symptomatic controls. We also measured the dimensions of 275 dry bones. We found significant correlations among the variables in the live subjects. We found significant differences between patients and controls in the variables that were measured. Stenoses were more prevalent in females. Dry bone measurements showed some sex differences, and stenosis mainly in vertebrae L4, L5 and S1.

https://journals.sagepub.com/doi/pdf/10.1177/147323000603400312

Comparative morphometry of the lower lumbar vertebrae: osteometry in dry bones and computed tomography images of patients with and without low back pain.

Background. Osteosarcoma is the most common primary malignant bone tumour. There is a high incidence of late presentation in the developing world, posing additional challenges in the treatment of this aggressive disease. Objective. To evaluate clinical outcomes of patients with osteosarcoma at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), a tertiary hospital in South Africa, and compare these with similar studies in the developing world. Methods. This was a retrospective study of 61 patients treated at CMJAH between 2007 and 2011, with a minimum follow-up of 1.3 years (range 1.3 - 6.3). Results. An average of 4.5 months elapsed before patients were first seen at the CMJAH tumour unit. Fifty-eight patients (95.1%) initially sought conventional medical care. Three patients (4.9%) presented with pathological fractures. All the patients underwent biopsy, performed an average of 3 weeks after arrival at the tumour unit. In most cases the delay was due to limited access to magnetic resonance imaging. Most patients ( n =41, 67.2%) were at Enneking stage 2B, 4 (6.6%) were at stage 2A and 16 (26.2%) were at stage 3. Of the patients, 13 (21.3%) underwent limb salvage procedures, 33 (54.1%) had amputations, 4 (6.6%) refused further treatment and 11 (18.0%) received palliative care only; 55 patients (90.2%) received chemotherapy. Two patients developed local recurrence, one of whom had an amputation and the other further wide excision. Two patients received palliative radiotherapy. Of the patients, 82.0% were HIV-negative, 4.9% HIV-positive and the rest of unknown status. At the time of the study, all but two patients, who came from other countries, were traceable or known to have died. Our overall 1-year and 5-year survival rates were 62.7% (95% confidence interval (CI) 49.1 - 73.9) and 38.1% (95% CI 24.6 - 51.4), respectively. Male patients and those with a higher Enneking stage had a poorer prognosis. Conclusion. Although most patients sought conventional medical care, unacceptable delays worsened survival. However, our survival rates are better than those in other developing countries. We advocate that professional, public and political awareness of osteosarcoma be improved as a matter of urgency, to facilitate rapid tertiary referral and expedite management.

/pdf/osteosarcoma-patient-outcomes-at-a-south-african-tertiary-71lfg0yr4e.pdf

Osteosarcoma patient outcomes at a South African tertiary hospital.

consecutive cases of osteosarcoma treated over a five-year period were reviewed retrospectively. The cases were notable for the advanced stage of disease at presentation with half the patients presenting with metastases, and unusually large mean tumour sizes. The majority of patients needed amputation for local control of the tumour. Although follow-up is short, a third of the patients are disease-free at a mean of 30 months and a sixth alive with metastases at a mean of 16 months. Half the patients are presumed or known to be dead. Presence of metastases at diagnosis and size greater than 10 cm were associated with a poor prognosis.

/pdf/outcomes-of-osteosarcoma-in-a-tertiary-hospital-3fvcwuq6xz.pdf

Outcomes of osteosarcoma in a tertiary hospital

Lumbar spinal stenosis is diagnosed by the clinical picture of radiculopathy and / or spinal claudication caused by narrowing of the spinal canal. Anatomical and radiological features correlate poorly with the clinical fea- tures, and are of little prognostic value. The natural history is very benign with fluctuating levels and types of symptoms. Indications for surgery must be individualized, but decompression is effective in the short and medium term. Fusion is only indicated in the case of instability.

/pdf/lumbar-spinal-stenosis-1j8iojl24v.pdf

Lumbar spinal stenosis

/pdf/private-practice-rwops-and-overtime-for-state-employed-2q22ariffi.pdf

Private practice (RWOPS) and overtime for state-employed specialists

/pdf/orthopaedic-research-in-south-africa-the-unstable-pot-2gbx08o0jn.pdf

Orthopaedic research in South Africa: the unstable pot

Aim: To determine how accurately pre-operative stress radiographs predict the final outcome in adolescent idiopathic scoliosis surgery. Methods: Records of 20 patients were reviewed retrospectively. Pre-operative correction was measured by comparing the initial Cobb angle of the main structural curves on plain standing radiographs to values measured at corresponding levels after correction on traction and fulcrum bending radiographs. Post-operative correction was obtained by measurements at corresponding levels of the instrumented and uninstrumented curves. Results: Mean correction of the main instrumented curve by traction was 24.2° (40.9%), and by fulcrum bending 32.3° (56.0%). Post-operative correction yielded a mean value of 41.1° (68.2%). Expressing pre-operative values as a percentage of final correction, traction views predicted 60%, and fulcrum bending radiographs 82% of the final correction. If agreement within 10° of preand post-operative values is regarded as clinically significant, only 18% of traction and 45% of fulcrum bending views came within that range. Discussion: We concluded that fulcrum bending views are of superior predictive value in terms of surgical correction to be expected, but still correlate poorly with final surgical correction achieved. Introduction Pre-operative assessment of the flexibility of scoliotic curves provides the surgeon with some information regarding the levels to be included in arthrodesis, the amount of correction that can be achieved safely if an anterior release is required, and whether a secondary curve should be treated with arthrodesis or not. Unfortunately the results of these stress views often bear little relation to the final surgical correction achieved. Methods employed to determine the flexibility of the curves include Cobb angle comparisons between standing and supine radiographs, traction radiographs, push prone radiographs, lateral bending radiographs with the patient supine or standing, and fulcrum bending radiographs. SAOJ Summer 2009 11/26/09 4:35 PM Page 18

Comparison of pre-operative correction X-rays with post-operative correction achieved in adolescent idiopathic scoliosis

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