sagittal balance and predictive equations to determine lumbopelvic compensatory patterns (LPCP).These equations are used to guide surgical decision making and technique selection.Although other lumbopelvic compensation equations are available, these have not been compared with the SRS-Schwab equation. ObjectivesThe aim was to evaluate sagittal balance and LPCP in younger and older adults with scoliosis and to compare the two most commonly used LPCP predictive equations (SRS-Schwab and Legaye).Methods EOS radiographic data from 41 adults with scoliosis (coronal Cobb > 10°; 51 ± 19 years) stratified into younger (n = 20) and older (n = 21) groups above and below the mean age was retrospectively analysed.T-tests were used to compare group characteristics and Fisher's exact tests were used to evaluate differences in SVA (sagittal vertical axis), PT (pelvic tilt) and PI (pelvic incidence)-LL (lumbar lordosis) mismatch thresholds.Agreement between SRS-Schwab and Legaye classification was evaluated using Kappa tests and Bland Altman plots.Results and discussion 62% of the older group and 10% of the younger group exceeded the SVA threshold of 40 mm (p < .001).86% of the older group and 20% of the younger group exceeded the 20°pelvic retroversion threshold (p < 0.001).Normal PI-LL mismatch ranges were more prevalent in the younger group (70%) than the older group (28%) (p < .001)when analysed through the SRS-Schwab equation.Legaye equation analysis revealed no difference in the prevalence of normal PI-LL ranges between the younger (15%) and older group (10%) (P = .66).Lumbar hyperlordosis was more prevalent in the younger (25%) than older group (5%) (p < .001)when analysed through the SRS-Schwab equation but no difference was observed between the younger (10%) and older group (0%) (p > .05)when analysed through the Legaye equation.Lumbar hypolordosis was more prevalent in the older (67%) than the younger group (5%) (p < .001)but no difference was observed between the older (90%) and younger group (75%) when analysed through the Legaye predictive equation (P = .33).Agreement between the SRS-Schwab and Legaye equations was poor for the whole (κ = 0.148), older (κ = 0.277) and young groups (κ = 0.039). Conclusion and significanceThis study confirms that older patients more often exhibit higher SVA and pelvic retroversion than younger patients.Whilst analysis through SRS-Schwab classification reveals that younger patients more often exhibit lumbar hyperlordosis than older patients who more often exhibit lumbar hypolordosis, analysis through the Legaye equations revealed no differences.There is poor agreement between the SRS-Schwab and Legaye classification equations.Clinicians are cautioned to exercise clinical judgement when evaluating their patients with these equations until more research is done.

Objectives The Rib Index, (RI), extracted from the double rib couture sign (DRCS) on lateral spinal radiographs to evaluate rib hump deformity in IS patients has been earlier introduced (Grivas at al 2000). Although various papers using the RI have been published, no study of its reproducibility was reported. To estimate the variations of the RI in a number of a pair set of lateral chest radiographs of healthy volunteers. The hypothesis was that the RI should have minimal variability for each patient having successive lateral radiographs.

Background The Rib Index, (RI), extracted from the double rib contour sign (DRCS) on lateral spinal radiographs to evaluate rib hump deformity, (RHD), in idiopathic scoliosis, (IS), patients, has been previously introduced. Although various papers using the RI have been published, no study on its reproducibility has been reported. The aim of this report is to estimate the variations of the RI in a number of a pair set of lateral chest radiographs (LCRs). The hypothesis was that the RI should have minimal variability for each subject having successive LCRs. Methods Seventy randomized patients who were treated in the hospital for lung diseases (mainly pneumonia or other communicable lung diseases), were initially included in the study. Each of these patients had two successive LCRs (named A and B group of radiographs) at the radiological department of the hospital, by the same technician, during the course of their treatment. The radiation source - patient distance was constant. LCRs obtained at an incorrect patient’s position, or from patients who underwent a thoracic intervention and all LCRs with symmetric hemi-thoraces were excluded from the study. The LCRs of 49 patients were deemed suitable for inclusion in the study. The RI was calculated in both (A and B) LCRs of each patient. The statistical analysis included the following techniques: paired t-test, Pearson correlation coefficient and intra- and inter-observer error using the formula (SD/√2)/2, where SD is this of the differences of the two sets of measurement (As-Bs). The SPSS v16 statistical package was used. Results In the 49 pairs of LCRs there was no statistical difference of the RI, (paired t-test p< 0.314). The RI in the A and B group of LCRs was perfectly correlated (correlation coefficient = 0,924, p < 0.0001). The intra-observer error was 0.0080 while the inter-observer error 0.0213 in terms of 95% CI. Conclusion The RI proves to be a reliable method to evaluate the thoracic deformity and the effect of surgical or non-operative treatment on the IS RHD. RI is a simple method, a safe reproducible way to assess the RHD based on lateral radiographs, without the need for any further special radiographs and exposure to additional radiation.

BACKGROUND:Review of literature reveals that in Idiopathic Scoliosis (IS) children, the post-operative rib hump (RH) correction using full transpedicular screw construct has never been compared to hybrid constructs, applying the Rib-Index (RI) method. Therefore the aim of this report is to study which of the above two constructs offers better postoperative Rib Hump Deformity (RHD) correction.METHODS:Twenty five patients with Adolescent Idiopathic Scoliosis (AIS) were operated using full pedicle screw construct or hybrid construct. Sixteen underwent full screw instrumentation (group A) and nine an hybrid one (group B). The median age for group A was 15 years and for group B 17.2 years. The RHD was assessed on the lateral spinal radiographs using the RI. The RI was calculated by the ratio of spine distances d1/d2, where d1 is the distance between the most extended point of the most extending rib contour and the posterior margin of the corresponding vertebra on the lateral scoliosis films and d2 is the distance from the least projected rib contour and the posterior margin of the same vertebra. Moreover the amount of RI correction was calculated by subtracting the post-operative RI from the pre-operative RI.RESULTS:Although within group A the RI correction was statistical significant (the pre-op RI was 1.93 and the post-op 1.37; p<0.001) and similarly in group B (the mean pre-op RI was 2.06 while the mean post-op 1.51; p=0.008), between group A and B the post-operative RI correction mean values were found to be no statistically significant, (p=0.803).CONCLUSION:Although the pre- and post-operative RI correction was statistically significant within each group, this did not happen post-operatively between the two groups. It appears that the RHD correction is not different, no matter what the spinal construct type was used. Provided that the full screw construct is powerful, the post-operative derotation and RHD correction was expected to be better than when an hybrid construct is applied, which is not the case in this study. It is therefore implied that the RHD results more likely from the asymmetric rib growth rather than from vertebral rotation, as it has been widely believed up to now. In 2013 Lykissas et al, reported that costoplasty combined with pedicle screws and vertebral derotation significantly improved RH deformity as opposed to pedicle screws and vertebral derotation alone. Another interesting implication is that the spinal deformity is the result of the thoracic asymmetry, implication in line with the late Prof. John Sevastikoglou's (Sevastik's) thoracospinal concept.

Conflicting reports exist regarding the surgical indications, timing, approach, staged or not operation, and spinal instrumentation for patients with spondylodiscitis. Therefore, we performed this study to evaluate the outcome of a series of patients with spondylodiscitis aiming to answer when and how to operate on these patients.