The direct cost of "Thriasio" school screening program

<p>Abstract</p> <p>Background</p> <p>There is great diversity in the policies for scoliosis screening worldwide. The initial enthusiasm was succeeded by skepticism and the worth of screening programs has been challenged. The criticisms of school screening programs cite mainly the negative psychological impact on children and their families and the increased financial cost of visits and follow-up radiographs. The purpose of this report is to evaluate the direct cost of performing the school screening in a district hospital.</p> <p>Methods</p> <p>A cost analysis was performed for the estimation of the direct cost of the "Thriasio" school-screening program between January 2000 and May 2006. The analysis involved all the 6470 pupils aged 6–18 years old who were screened at schools for spinal deformities during this period. The factors which were taken into consideration in order to calculate the direct cost of the screening program were a) the number of the examiners b) the working hours, c) the examiners' salary, d) the cost of transportation and finally e) the cost of examination per child.</p> <p>Results</p> <p>During the examined period 20 examiners were involved in the program and worked for 1949 working hours. The hourly salary for the trainee doctors was 6.80 euro, for the Health Visitors 6.70 euro and for the Physiotherapists 5.50 euro in current prices. The cost of transportation was 32 euro per year. The direct cost for the examination of each child for the above studied period was calculated to be 2.04 euro.</p> <p>Conclusion</p> <p>The cost of our school-screening program is low. The present study provides a strong evidence for the continuation of the program when looking from a financial point of view.</p

Surgical and conservative treatment of patients with congenital scoliosis: α search for long-term results

<p>Abstract</p> <p>Background</p> <p>In view of the limited data available on the conservative treatment of patients with congenital scoliosis (CS), early surgery is suggested in mild cases with formation failures. Patients with segmentation failures will not benefit from conservative treatment. The purpose of this review is to identify the mid- or long-term results of spinal fusion surgery in patients with congenital scoliosis.</p> <p>Methods</p> <p>Retrospective and prospective studies were included, reporting on the outcome of surgery in patients with congenital scoliosis. Studies concerning a small numbers of cases treated conservatively were included too. We analyzed mid-term (5 to 7 years) and long-term results (7 years or more), both as regards the maintenance of the correction of scoliosis and the safety of instrumentation, the early and late complications of surgery and their effect on quality of life.</p> <p>Results</p> <p>A small number of studies of surgically treated patients were found, contained follow-up periods of 4-6 years that in the most cases, skeletal maturity was not yet reached, and few with follow-up of 36-44 years. The results of bracing in children with congenital scoliosis, mainly in cases with failure of formation, were also studied.</p> <p>Discussion</p> <p>Spinal surgery in patients with congenital scoliosis is regarded in short as a safe procedure and should be performed. On the other hand, early and late complications are also described, concerning not only intraoperative and immediate postoperative problems, but also the safety and efficacy of the spinal instrumentation and the possibility of developing neurological disorders and the long-term effect these may have on both lung function and the quality of life of children.</p> <p>Conclusions</p> <p>Few cases indicate the long-term results of surgical techniques, in the natural progression of scoliosis. Similarly, few cases have been reported on the influence of conservative treatment.</p> <p>In conclusion, patients with segmentation failures should be treated surgically early, according to the rate of deformity formation and certainly before the pubertal growth spurt to try to avoid cor- pulmonale, even though there is lack of evidence for that in the long-term. Furthermore, in patients with formation failures, further investigation is needed to document where a conservative approach would be necessary.</p

Estudo comparativo da medida da rotação vertebral pelos métodos de Nash & Moe e método de Raimondi Comparative study of the measurements of the vertebral rotation using Nash & Moe and Raimondi methods

Neste estudo foram avaliados a sensibilidade e precisão dos métodos de Nash e Moe e de Raimondi para a medida da rotação da vértebra torácica e lombar.Três cirurgiões de coluna avaliaram, independentemente, as radiografias de uma vértebra torácica (T9) e de uma vértebra lombar (L2) com graus de rotação que variaram de 0º a 60º e estabeleceram valores de acordo com o método de Nash e Moe e o método de Raimondi.Foram estudadas a concordância entre os examinadores para um determinado método, a variação das medidas obtidas na vértebra torácica e lombar a partir de uma mesma rotação real conhecida e a correlação entre um valor real conhecido de rotação vertebral e a sua estimativa pelos métodos utilizados no estudo . Os resultados mostraram boa concordância entre os examinadores para o método de Nash e Moe, tanto para a vértebra torácica (k médio = 0,66), quanto para a lombar (k médio = 0,80). Pelo método de Raimondi não houve diferença significativa entre os examinadores para a vértebra torácica, no entanto, para a vértebra lombar houve baixa reprodutibilidade do método.Para uma mesma rotação na vértebra torácica e lombar os resultados foram não concordantes pelo método de Nash e Moe, e pelo método de Raimondi os valores observados para a vértebra torácica foram significativamente maiores que os da vértebra lombar. A correlação entre os valores reais e as estimados pelo método de Raimondi para a vértebra torácica mostrou que houve diferença significativa produzida em função da rotação até 20º graus, já para a vértebra lombar, os valores obtidos foram muito próximos do real.<br>The sensibility and precision of the Nash and Moe and Raimondi methods were evaluated in this study for the measurement of the rotation of the thoracic and the lumbar vertebra. Three spine surgeons evaluated, independently, the x-rays of a thoracic vertebra (T9) and of a lumbar vertebra (L2) with varying rotational degrees from 0º to 60º and established values in agreement with the Nash and Moe method and the Raimondi method. The agreement among the examiners as to a certain method, the variation of the measures obtained for the thoracic and the lumbar vertebra, starting from a same known actual rotation and the correlation between a known true value of vertebral rotation and its forecast prepared through the methods used in the study were perused. The results showed good agreement among the examiners for the Nash and Moe method, so much for the thoracic vertebra (average k = 0,66), as for the lumbar (average k = 0,80). Using the Raimondi method there was no significant difference among the examiners for the thoracic vertebra. However, there was a low reproducibility of the method for the lumbar vertebra. For a same rotation of the thoracic and lumbar vertebra the results were non-concordant for the method of Nash and Moe, and for the Raimondi method the values observed for the thoracic vertebra were significantly larger than the ones for the lumbar vertebra. The correlation between the true values and the estimated values for the Raimondi method for the thoracic vertebra showed that there was a significant difference produced in function of the rotation up to 20º degrees, however for the lumbar vertebra the obtained values were very close to the actual

Horizontal body and trunk center of mass offset and standing balance in scoliotic girls

In adolescent idiopathic scoliotic girls, postural imbalance is attributed to a sensory rearrangement of the motor system on the representation of the body in space. The objectives of this study were to test if the anteroposterior (AP), mediolateral (ML) and resultant body–head and trunk center of mass (COM) horizontal offsets were similar in able-bodied and scoliotic girls and if these offsets were related to the center of pressure displacements. A total of 21 adolescent idiopathic scoliosis girls and 20 able-bodied girls participated in this study. Their body COM position and that of the head and trunk were estimated according to Damavandi et al. (Med Eng Phys 31:1187–1194, 2009). The COP range and speed in both AP and ML axes were calculated from force plate measurements in quiet standing. The AP offset of the able-bodied group was anterior to the body COM by 11.0 ± 15.9 mm, while that of the scoliotic group was posterior to it by −17.3 ± 11.2 mm. The able-bodied group maintained their head–trunk segment COM more to the right by 14.1 ± 13.1 mm, while that of the scoliotic group was nearly over their body centerline. The scoliotic girls presented higher values for COP range and COP speed than the able-bodied girls. The resultant COM offset was correlated with both the ML COP range and speed only for the scoliotic girls. The small ML COM offset in the scoliotic girls was attributed to a compensatory action of the spinal deformity in the frontal plane resulting in a backward resultant COM offset to regain postural balance concomitant to an increase in the ML neuromuscular demand

Rasterstereographic analysis of axial back surface rotation in standing versus forward bending posture in idiopathic scoliosis

The forward bending test according to Adams and rib hump quantification by scoliometer are common clinical examination techniques in idiopathic scoliosis, although precise data about the change of axial surface rotation in forward bending posture are not available. In a pilot study the influence of leg length inequalities on the back shape of five normal subjects was clarified. Then 91 patients with idiopathic scoliosis with Cobb-angles between 20° and 82° were examined by rasterstereography, a 3D back surface analysis system. The axial back surface rotation in standing posture was compared with that in forward bending posture and additionally with a scoliometer measurement in forward bending posture. The changes of back shape in forward bending posture were correlated with the Cobb-angle, the level of the apex of the scoliotic primary curve and the age of the patient. Averaged over all patients, the back surface rotation amplitude increased from 23.1° in standing to 26.3° in forward bending posture. The standard deviation of this difference was high (6.1°). The correlation of back surface rotation amplitude in standing with that in forward bending posture was poor (R2=0.41) as was the correlation of back surface rotation in standing posture with the scoliometer in forward bending posture measured rotation (R2=0.35). No significant correlation could be found between the change of back shape in forward bending and the degree of deformity (R2=0.07), likewise no correlation with the height of the apex of the scoliosis (R2=0.005) and the age of the patient (R2=0.001). Before forward bending test leg length inequalities have to be compensated accurately. Compared to the standing posture, forward bending changes back surface rotation. However, this change varies greatly between patients, and is independent of the type and degree of scoliosis. Furthermore remarkable differences were found between scoliometer measurement of the rib hump and rasterstereographic measurement of the vertebral rotation. Therefore the forward bending test and the identification of idiopathic scoliosis rotation by scoliometer can be markedly different compared to rasterstereographic surface measurement in the standing posture