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A Survey of Current Controversies in Scoliosis Surgery in the United Kingdom

Michael, Anthony L. R., FRCS (Tr & Orth)*; Loughenbury, Peter R., BSc (Hons), MRCS; Rao, Abhay S., FRCS (Orth); Dunsmuir, Robert A., BSc (Hons), FRCS (Ed), FRCS (Orth); Millner, Peter A., BSc, FRCS (Orth)

doi: 10.1097/BRS.0b013e31825409f4

Study Design. A 10-point questionnaire was constructed to identify the philosophy of surgeons on various aspects of scoliosis surgery, such as choice of implant, bone graft, autologous blood transfusion, cord monitoring, and computer-assisted surgery. Comparisons were then made with recommendations published in the spinal literature.

Objective. To determine certain aspects of the current practice of scoliosis surgery in the United Kingdom.

Summary of Background Data. Guidelines for good clinical practice in spinal deformity surgery are available in the United Kingdom but do not cover a number of controversial issues.

Methods. Consultants and fellows attended the 2009 British Scoliosis Society meeting. Fifty questionnaires were completed by 45 consultants and 5 fellows.

Results. All pedicle screw constructs favored by 25 of 50, hybrid 24 of 50 (1 undecided). Posterior construct of fewer than 10 levels, 20 of 50 would not cross-link, 11 of 50 used 1, and 19 of 20 used 2 or more. More than 10 levels 17 of 50 considered cross-links unnecessary, 4 of 50 used 1 and 29 of 50 used 2 or more. Eighty-eight percent preferred titanium alloy implants, whereas others used a mixture of stainless steel and cobalt chrome. When using bone graft, respondents used bone substitutes (24), iliac crest graft (14), allograft (12) and demineralized bone matrix (9) in addition to local bone. Ten of 50 would use recombinant bone morphogenetic protein (3 for revision cases only). Thirty-nine of 50 routinely used intraoperative cell salvage and 4 of 50 never used autologous blood. All used cord monitoring: sensory (19 of 50), motor (2 of 50), and combined (29 of 50). None used computer-aided surgery. Twenty-six operated alone, 12 operated in pairs, and 12 varied depending on type of case.

Conclusion. This survey shows interesting variations in scoliosis surgery in the United Kingdom. It may reflect the conflicting evidence in the literature.

A 10-point questionnaire was completed by consultants and fellows attending the 2009 British Scoliosis Society meeting. This identifi ed the philosophy of surgeons on certain key aspects of scoliosis surgery and has brought to light interesting variations in practice in the United Kingdom.

*Sheffield Children's Hospital and the Northern General Hospital, Sheffield, United Kingdom

Leeds General Infi rmary, Leeds, United Kingdom.

Address correspondence and reprint requests to Peter Loughenbury, BSc (Hons), MRCS, SpR Trauma and Orthopaedics, 2 Methley Grove, Chapel Allerton, Leeds, LS7 3PA; E-mail:

Acknowledgment date: August 17, 2011. First revision date: February 9, 2012. Second revision date: February 20, 2012. Acceptance date: February 27, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.