Inter- and intrarater reliability of measuring lengthening of magnetically controlled growing rods on digital radiographs.

PURPOSE: The aim of this study was to determine inter- and intraobserver reliability of delta rod extension, and total rod length measured on digital x-rays in patients with early onset scoliosis (EOS) treated with magnetically controlled growing rods (MCGR). For the last decade, patients with EOS have been treated with MCGR. Replacement of MCGR relies heavily on the measurement done at every lengthening session. Only a few studies have looked at inter- and intraobserver reliability of rod lengthening, and none have used the delta extension before. METHODS: 202 radiographs presented in random order were rated and measured twice with at least a 14-day interval and differing order of the radiographs. The measuring was done at both rods. All x-rays came from 15 patients diagnosed with EOS and treated with MCGR from 2009 until 2019. The total extension length and the delta extension (the difference in total extension length between two lengthening in succession) were measured, and the intraclass correlation coefficient (ICC) calculated for both measurements RESULTS: Intrarater ICC scores varied from moderate to good, but non-significantly. Interrater reliability increased significantly from moderate (ICC 0.72 [0.68; 0.76] and 0.73 [0.69; 0.77] to excellent (ICC 0.91 [0.88; 0.93] and 0.97 [0.96: 0.98]), when examining delta extension every sixth instead of every second month. CONCLUSION: Measuring rod lengthening on x-rays can be done every 6 months, with an ample reliability. The ICC's for the delta extension with 2-3 months interval were only moderately precise, compared to the near perfect ICC's for the total extension length.

Comparison of interventions for lumbar disc herniation: a systematic review with network meta-analysis.

BACKGROUND: Implants for use in disc herniation surgery have been commercially available for some time. Several clinical trials have shown promising results. There are now a wide variety of surgical methods for treating lumbar disc herniation. PURPOSE: The objective of this systematic review was to compare all current surgical methods for disc herniation, including newer methods with implants for annulus repair and dynamic stabilization. STUDY DESIGN: Systematic review and network meta-analysis. METHODS: PRISMA-P guidelines were followed in this review. Literature search in PubMed, Embase, and Cochrane library databases identified eligible randomized controlled trials (RCT) studies comparing interventions for lumbar disc surgery. The investigated outcomes were: changes in pain score, disability score and reoperation rate with a minimum follow-up of 1 year. Risk of bias was assessed in concordance with Cochrane Neck and Back Review Group recommendation. A network meta-analysis was performed using gemtc and BUGSnet software, and each outcome evaluated using Confidence in Network Meta-Analysis (CINeMA). RESULTS: Thirty-two RCT studies, with 4,877 participants, and eight different interventions were identified. A significant difference was seen in change of pain score, as all treatments were superior to conservative treatment and percutaneous discectomy. This difference was only found to be of clinically importance when comparing conservative treatment and dynamic stabilization. There was no significant difference in reoperation rates or change in disability score, regardless of treatment. However, SUCRA plots showed a trend in ranking annulus repair and dynamic stabilization highest. Risk of bias assessment showed that 15 studies had a high overall risk of bias. Meta-regression with risk of bias as covariate did not indicate any influence in risk of bias on the model. Confidence in Network Meta-Analysis evaluation showed a high level of confidence for all treatment comparisons. CONCLUSIONS: With this network meta-analysis, we have aimed to compare all treatments for herniated lumbar disc in one large comprehensive systematic review and network meta-analysis. We have compared across the three main outcomes: disability score, pain score and reoperation rate. We were not able to rank one single treatment as the best. Most of the treatment performed at the same level. However percutaneous discectomy and conservative treatment consistently performed worse than the other treatments. In general, the CINeMA evaluation according to the GRADE recommendations gave a high level of confidence for the study comparisons.

Cumulative radiation exposure during current scoliosis management.

INTRODUCTION: Patients undergoing scoliosis management are exposed to repeated radiological imaging. Previous studies have shown an increase in incidence of cancer among these patients. The primary aim of this study was to evaluate the radiographic examinations and cumulative radiation dose to which scoliotic patients are exposed. A secondary aim was to compare in-house algorithms of scoliosis management and radiographic follow-up to international spine centres and current consensus literature. MATERIALS AND METHODS: A single-centre retrospective review evaluating type and frequency of radiographic imaging and total cumulative radiation exposure to patients treated for scoliosis. Inclusions: patients followed for idiopathic scoliosis in the years 2013-2016. A survey asking for information on management and radiological follow-up algorithms was sent to a number of international spine centres for comparison with the in-house algorithm. RESULTS: Patients who underwent surgery received an approximately ten-fold higher median cumulative radiation dose than those treated conservatively. A variety of radiological follow-up algorithms among eight spine centres was observed. CONCLUSIONS: Cumulative radiation dose during scoliosis treatment varies substantially depending on radiographic follow-up protocol, intraoperative and ancillary imaging. By using low-dose X-ray systems in combination with a low-dose protocol for intraoperative navigation, it is possible to keep exposure to patients at a minimum while still providing optimal care. FUNDING: none. TRIAL REGISTRATION: not relevant.

EOS Micro-dose Protocol: First Full-spine Radiation Dose Measurements in Anthropomorphic Phantoms and Comparisons with EOS Standard-dose and Conventional Digital Radiology.

STUDY DESIGN: A comparative study of radiation dose measured in anthropomorphic phantoms. OBJECTIVES: The aim of this study was to first report the first organ dose and effective dose measurements in anthropomorphic phantoms using the new EOS imaging micro-dose protocol in full-spine examinations, and to compare these measurements of radiation dose to measurements in the EOS standard-dose protocol and conventional digital radiology (CR). SUMMARY OF BACKGROUND DATA: Few studies evaluating organ dose and effective dose for the EOS low-dose scanner exist, and mainly for the standard-dose protocol. To the best of our knowledge, no studies of effective dose based on anthropomorphic phantom measurements exist for the new micro-dose protocol. METHODS: Two anthropomorphic phantoms, representing a 5-year-old (pediatric) and a 15-year-old (adolescent). The phantoms were exposed to EOS micro-dose and standard-dose protocols during full-spine imaging. Additionally, CR in scoliosis settings was performed. For all modalities, organ doses were measured and effective doses were calculated using thermoluminescent dosimeters. RESULTS: We found a 17-fold reduction (94%) of effective dose in micro-dose protocol compared with our CR system in the adolescent phantom. Micro-dose versus standard-dose protocol, showed a 6-fold reduction (83%), and for standard-dose versus our CR system a 2.8-fold reduction (64%) reduction of effective dose was observed.For the pediatric phantom, a 5-fold reduction (81%) of effective dose in micro-dose protocol compared to our CR system was observed. Micro-dose versus standard-dose protocol, showed a seven-fold (86%) reduction. However, we observed an increase in absorbed dose of 38% when comparing the EOS standard-dose protocol with our CR system. CONCLUSION: The EOS imaging micro-dose option exposes patients to lower radiation doses than any currently available modality for full-spine examination. Expected reduction of dose was established for the adolescent phantom when comparing CR and standard-dose protocol. However, no reduction of effective dose with EOS standard-dose protocol compared to our reference CR system was observed in the pediatric phantom. LEVEL OF EVIDENCE: N/A.

[Trampoline accident with anterior knee dislocation caused popliteal artery disruption]. / Knæledsluksation og skade på arteria poplitea efter trampolinspring.

Only a few reports describe the risk of neurovascular damage following knee dislocation while trampolining. A 16 year-old male in a trampoline accident, sustained multi-ligament damage and occlusion of the popliteal artery. The occlusion did not show clinically until 24 hours after the trauma. He underwent vascular surgery (short saphenous bypass). We recommend implementing algorithms, for the management of suspected knee dislocation and possible accompanying neurovascular injuries in all trauma centers.