Secondary curve behaviour in Lenke IC class adolescent idiopathic scoliosis following video assisted thoracoscopic spinal fusion

Introduction. Ideally after selective thoracic fusion for Lenke Class IC (i.e. major thoracic / secondary lumbar) curves, the lumbar spine will spontaneously accommodate to the corrected position of the thoracic curve, thereby achieving a balanced spine, avoiding the need for fusion of lumbar spinal segments1. The purpose of this study was to evaluate the behaviour of the lumbar curve in Lenke IC class adolescent idiopathic scoliosis (AIS) following video-assisted thoracoscopic spinal fusion and instrumentation (VATS) of the major thoracic curve. Methods. A retrospective review of 22 consecutive patients with AIS who underwent VATS by a single surgeon was conducted. The results were compared to published literature examining the behaviour of the secondary lumbar curve where other surgical approaches were employed. Results. Twenty-two patients (all female) with AIS underwent VATS. All major thoracic curves were right convex. The average age at surgery was 14 years (range 10 to 22 years). On average 6.7 levels (6 to 8) were instrumented. The mean follow-up was 25.1 months (6 to 36). The pre-operative major thoracic Cobb angle mean was 53.8° (40° to 75°). The pre-operative secondary lumbar Cobb angle mean was 43.9° (34° to 55°). On bending radiographs, the secondary curve corrected to 11.3° (0° to 35°). The rib hump mean measurement was 15.0° (7° to 21°). At latest follow-up the major thoracic Cobb angle measured on average 27.2° (20° to 41°) (p<0.001 – univariate ANOVA) and the mean secondary lumbar curve was 27.3° (15° to 42°) (p<0.001). This represented an uninstrumented secondary curve correction factor of 37.8%. The mean rib hump measured was 6.5° (2° to 15°) (p<0.001). The results above were comparable to published series when open surgery was performed. Discussion. VATS is an effective method of correcting major thoracic curves with secondary lumbar curves. The behaviour of the secondary lumbar curve is consistent with published series when open surgery, both anterior and posterior, is performed.

Computed tomography analysis of sagittal plane parameters in adolescent idiopathic scoliosis treated by video assisted thoracoscopic spinal fusion and instrumentation

One of the primary treatment goals of adolescent idiopathic scoliosis (AIS) surgery is to achieve maximum coronal plane correction while maintaining coronal balance. However maintaining or restoring sagittal plane spinal curvature has become increasingly important in maintaining the long-term health of the spine. Patients with AIS are characterised by pre-operative thoracic hypokyphosis, and it is generally agreed that operative treatment of thoracic idiopathic scoliosis should aim to restore thoracic kyphosis to normal values while maintaining lumbar lordosis and good overall sagittal balance. The aim of this study was to evaluate CT sagittal plane parameters, with particular emphasis on thoracolumbar junctional alignment, in patients with AIS who underwent Video Assisted Thoracoscopic Spinal Fusion and Instrumentation (VATS). This study concluded that video-assisted thoracoscopic spinal fusion and instrumentation reliably increases thoracic kyphosis while preserving junctional alignment and lumbar lordosis in thoracic AIS.

Fusionless scoliosis correction using shape memory alloy staples

Severe spinal deformity in young children is a formidable challenge for optimal treatment. Standard interventions for adolescents, such as spinal deformity correction and fusion, may not be appropriate for young patients with considerable growth remaining. Alternative surgical options that provide deformity correction and protect the growth remaining in the spine are needed to treat this group of patients 1, 2. One such method is the use of shape memory alloy staples. We report our experience to date using video-assisted thoracoscopic insertion of shape memory alloy staples. A retrospective review was conducted of 13 patients with scoliosis, aged 7 to 13 years, who underwent video-assisted thoracoscopic insertion of shape memory staples. In our experience, video-assisted thoracoscopic insertion of shape memory alloy staples is a safe procedure with no complications noted. It is a reliable method of providing curve stability, however the follow up results to date indicate that the effectiveness of the procedure is greater in younger patients.

Experiences of the FIRST LEGO League in China and Australia

FIRST (For Inspiration and Recognition of Science and Technology) was initiated in the U.S. by accomplished inventor Dean Kamen in 1989. FIRST LEGO League (FLL) is one of the five competitions conducted by this organization. Dean’s vision was “to create a world where science and technology are celebrated……where young people dream of becoming science and technology heroes”. Each year FLL creates opportunities for young people aged 9-16 to engage in problem solving, teamwork and collaborative learning around a real-world theme. In the 2009/2010 season, more than 145,000 young people in over 50 countries participated in this competition. As they tackle the challenges; they construct and de-construct their own knowledge through hands-on engagement in a constructivist learning environment. The challenges are presented at least eight weeks before the competition. In most events the participants are judged in four categories - robot game, robot design, team project and team challenge. “Gracious professionalism” is an essential element of the competition. This paper compares and contrasts the FLL in China and Australia and presents some of the achievements of the event. It also highlights some of the models which have been adopted in the two countries to facilitate participation. The educational benefits of embedding the FLL will also be discussed.

Dark humour invigorates familiar fables ; a review

THEATRE: Grimm Tales. By Carol Ann Duffy and Tim Supple. Queensland Theatre Company, Brisbane. November 16. QUEENSLAND Theatre Company concludes its season with Grimm Tales, Carol Ann Duffy and Tim Supple's adaptation of classic cautionary tales as set down by the Brothers Grimm in the 19th century. This programming decision is clearly designed to present fun family entertainment as Christmas approaches. In Grimm Tales, well-known stories such as Hansel and Gretel, Snow White and Rumpelstiltskin pack a little more punch than in your standard picture book. Duffy and Supple's play is by no means the sort of poetic, postmodern or politicised adaptation of the fairytale we see from writers such as Angela Carter, and it is not intended to be subversive or to question the social and gender assumptions that underpin the tales. Start of sidebar. Skip to end of sidebar. End of sidebar. Return to start of sidebar. Rather, a return to the grislier original incarnations of the tales - the wicked stepsisters who lop off parts of their feet to fit the slipper and win the prince, or the hare so confused by the hedgehog's stratagem to make him think he is losing the race, he runs himself to death - has a comic effect. In this production, directed by Michael Futcher, heightened performances from some of Brisbane's best comic and physical actors, live music and an open, acknowledged relationship with the audience establish the atmosphere for the piece. While the production is a little sombre and slow to start with the first tale, Hansel and Gretel, the knowingness and almost slapstick quality with which the cast plays out the gruesome, scatological or silly moments in the other tales are well pitched to carry the comedy. The action is supported by a fantastic set by Greg Clarke of wooden planked walls, stairs and walkways which, with the help of David Walter's lighting design, is transformed into forests, ballrooms and castles as the cast moves up, over and under it. The overall highlight is probably the cast Futcher has brought together. Established QTC actors Eugene Gilfedder, Lucas Stibbard and Scott Witt, and emerging QTC actor Melanie Zanetti, join Liz Buchanan, Dan Crestani and Emma Pursey, all well known for their independent work in Brisbane but making their mainstage debut for the QTC. Every one of them metamorphoses with ease from character to character, human to animal, and central player to support. There is nothing particularly new in Grimm Tales, and it doesn't try to do anything more (or, indeed, less) than entertain, but skilful direction and a strong cast ensure it succeeds on those terms.

Tailoring secretion of proteoglycan 4 (PRG4) in tissue-engineered cartilage

Articular cartilage provides a low-friction surface for joint articulation, with boundary lubrication facilitated by proteoglycan 4 (PRG4), which is secreted by chondrocytes of the superficial zone. Chondrocytes from different zones are phenotypically distinct, and their phenotypes in vitro are influenced by the system in which they are cultured. We hypothesized that culturing cells from the superficial (S) zone in two-dimensional monolayer or three-dimensional alginate would affect their synthesis of PRG4, and that subsequently seeding them atop alginate-recovered cells from the middle/ deep (M) zone in various proportions would result in tissue-engineered constructs with varying levels of PRG4 secretion and matrix accumulation. During monolayer culture, S cells retained their PRG4-secreting phenotype, whereas in alginate culture the percentage of cells secreting PRG4 decreased with time. Constructs formed with increasing percentages of S cells decreased in thickness and matrix accumulation, depending on both the culture conditions before construct formation and the S-cell density. PRG4-secreting cells were localized to the S-cell seeded construct surface, with secretion rates of 0.1–4 pg/cell/day or 0.1–1 pg/cell/day for constructs formed with monolayer-recovered or alginate-recovered S cells, respectively. Tailoring secretion of PRG4 in cartilage constructs may be useful for enhancing low-friction properties at the articular surface, while maintaining other surfaces free of PRG4 for enhancing integration with surrounding tissues.

Tools and methods for capturing Twitter data during natural disasters

During the course of several natural disasters in recent years, Twitter has been found to play an important role as an additional medium for many–to–many crisis communication. Emergency services are successfully using Twitter to inform the public about current developments, and are increasingly also attempting to source first–hand situational information from Twitter feeds (such as relevant hashtags). The further study of the uses of Twitter during natural disasters relies on the development of flexible and reliable research infrastructure for tracking and analysing Twitter feeds at scale and in close to real time, however. This article outlines two approaches to the development of such infrastructure: one which builds on the readily available open source platform yourTwapperkeeper to provide a low–cost, simple, and basic solution; and, one which establishes a more powerful and flexible framework by drawing on highly scaleable, state–of–the–art technology.

CT and X-Ray analysis of sagittal curve changes following thoracoscopic anterior scoliosis surgery

Normal thoracic kyphosis Cobb angle for T5-T12 is most commonly reported as a range of 20-40º [1]. Patients with adolescent idiopathic scoliosis (AIS) exhibit a reduced thoracic kyphosis or hypokyphosis [2] accompanying the coronal and rotary distortion components. As a result, surgical restoration of the thoracic kyphosis while maintaining lumbar lordosis and overall sagittal balance is a critical aspect of achieving good clinical outcomes in AIS patients. Previous studies report an increase in thoracic kyphosis after anterior surgical approaches [3] and a flattening of sagittal contours following posterior approaches [4]. Difficulties with measuring sagittal parameters on radiographs are avoided with reformatted sagittal CT reconstructions due to the superior endplate clarity afforded by this imaging modality and are the subject of analysis in this study.

CT and radiographic analysis of sagittal profile changes after thoracoscopic anterior scoliosis surgery

Background. Previous studies report an increase in thoracic kyphosis after anterior approaches and a flattening of sagittal contours following posterior approaches. Difficulties with measuring sagittal parameters on radiographs are avoided with reformatted sagittal CT reconstructions due to the superior endplate clarity afforded by this imaging modality. Methods. A prospective study of 30 Lenke 1 adolescent idiopathic scoliosis (AIS) patients receiving selective thoracoscopic anterior spinal fusion (TASF) was performed. Participants had ethically approved low dose CT scans at minimum 24 months after surgery in addition to their standard care following surgery. The change in sagittal contours on supine CT was compared to standing radiographic measurements of the same patients and with previous studies. Inter-observer variability was assessed as well as whether hypokyphotic and normokyphotic patient groups responded differently to the thoracoscopic anterior approach. Results. Mean T5-12 kyphosis Cobb angle increased by 11.8 degrees and lumbar lordosis increased by 5.9 degrees on standing radiographs two years after surgery. By comparison, CT measurements of kyphosis and lordosis increased by 12.3 degrees and 7.0 degrees respectively. 95% confidence intervals for inter-observer variability of sagittal contour measurements on supine CT ranged between 5-8 degrees. TASF had a slightly greater corrective effect on patients who were hypokyphotic before surgery compared with those who were normokyphotic. Conclusions. Restoration of sagittal profile is an important goal of scoliosis surgery, but reliable measurement with radiographs suffers from poor endplate clarity. TASF significantly improves thoracic kyphosis and lumbar lordosis while preserving proximal and distal junctional alignment in thoracic AIS patients. Supine CT allows greater endplate clarity for sagittal Cobb measurements and linear relationships were found between supine CT and standing radiographic measurements. In this study, improvements in sagittal kyphosis and lordosis following surgery were in agreement with prior anterior surgery studies, and add to the current evidence suggesting that anterior correction is more capable than posterior approaches of addressing the sagittal component of both the instrumented and adjacent non instrumented segments following surgical correction of progressive Lenke 1 idiopathic scoliosis.