Incidence of cancer in adolescent idiopathic scoliosis patients treated 25 years previously.

PURPOSE: To report the incidence of cancer in a cohort of adolescent idiopathic scoliosis (AIS) patients treated 25 years previously. METHODS: 215 consecutive AIS patients treated between 1983 and 1990 were identified and requested to return for clinical and radiographic examination. The incidence of cancer was determined through chart review and follow-up interviews. Using the original radiographic log file that included patient position, mAs, kV and the total number of X-rays taken, a radiation physicist calculated the total radiation dose during treatment and follow-up adjusted for BMI and sex. RESULTS: From the original cohort of 215 consecutive AIS patients, radiation information was available in 211 of the patients, and medical charts were available in 209 AIS patients. 170 (83 %) of the 205 AIS patients participated in the follow-up study with questionnaires. The calculated mean total radiation exposure was 0.8-1.4 mSV per examination and 2.4-5.6 mSv/year. An average of 16 radiographs were taken during the treatment period. Nine AIS patients developed cancer, mostly breast (3) and endometrial (4). The AIS patients had a relative risk of 4.8 (CI 2.3-5.8, p < 0.000) for developing cancer compared to the normal Danish population. CONCLUSIONS: The overall cancer rate in this AIS cohort was 4.3 % which is five times higher than compared to the age-matched Danish population, and endometrial and breast cancer was most frequent. The radiation dose applied to the patients in this study, is comparable to modern equipment. This is to our knowledge the first study to report increased rates of endometrial cancers in a cohort of AIS patients, and future attention is needed to reduce the radiation dose distributed to the AIS patients both pre-operatively and during surgery.

Rate of Unsuspected Malignancy in Patients With Vertebral Compression Fracture Undergoing Percutaneous Vertebroplasty.

STUDY DESIGN: Retrospective study. OBJECTIVE: To determine the malignancy rate and histology in bone biopsies obtained during PVP for VCF. SUMMARY OF BACKGROUND DATA: Osteoporotic vertebral compression fractures (VCF) affect approximately 20% of postmenopausal women and can lead to long-term disability. Percutaneous vertebroplasty (PVP) is a minimally invasive procedure, primarily used in patients with severe pain after VCF. Even with a thorough clinical examination, magnetic resonance imaging (MRI) scans, and blood samples, some fractures maybe caused by an underlying malignant disease. METHODS: 144 consecutive patients underwent PVP for painful VCF, at the Center for Spine Surgery and Research, Middelfart Hospital. All patients had bone biopsies obtained during the PVP, and these biopsies were sent to the Department for Pathology at Vejle Sygehus for histologic diagnosis. RESULTS: About 144 patients were included in this study. The majority of the biopsy specimens (137, 95.1%) were acceptable for histological diagnosis. One hundred and twenty nine (89.6%) biopsies showed no signs of malignancy. Seven (4.9 %) were positive for malignancy. One biopsy was positive for MGUS. Seven (4.9 %) of the biopsies were unsuitable for histologic diagnosis. CONCLUSION: Our study shows an incidence of unsuspected malignancy in biopsies during PVP of 4.9%. Conservative treatment with analgesics and brace can potentially delay diagnosis and treatment of underlying malignant disease. We recommend biopsy during PVP as a standard procedure, to insure not to overlook any underlying malignancy despite the MRI-scan, blood analysis, and clinical examination being inconspicuous.

Health-related quality-of-life in adolescent idiopathic scoliosis patients 25 years after treatment.

BACKGROUND: Since 1962 to the mid eighties the Harrington Rod instrumentation was the Golden standard for surgical treatment of Adolescent Idiopathic Scoliosis (AIS). The Boston braces were introduced in the 1970´s and are still used as a conservative treatment, for curves less than 40°. Very few long-term studies exists, focusing on the health related quality of life. The purpose of this study was to evaluate the long-term health related outcome, in a cohort of AIS patients, treated 25 years ago. METHOD: 219 consecutive patients treated with Boston brace (Brace) or posterior spinal fusion (PSF) using Harrington- DDT instrumentation between 1983 and 1990 at Rigshospitalet Copenhagen, were invited to participate in a long-term evaluation study. A validated Danish version of the Scoliosis Research Society 22R (SRS22R) and Short Form-36 (SF36v1) were administrated to the patients two weeks before the clinical and radiological examination. RESULTS: 159 (72,6 %) patients participated in the clinical follow up and questionnaires, 11 patients participated only in the questionnaires, 8 emigrated, 4 were excluded due to progressive neurological disease and 2 were deceased. The total follow up was 170 patients (83 %), and the average follow up was 24.5 years (22-30 years). SRS22R domain scores were within the range described as normal for the general population with no statistical difference between the groups except in the Satisfaction domain, where the PSF group had better scores than the braced group. The SF36 PCS and MCS scores in both AIS cohorts were similar to the scores for the general population. CONCLUSION: HRQOLs, as measured by the SRS22R and SF-36, of adult AIS patients treated with Boston brace or PSF during adolescence were similar to the general population. No clinical progression of the deformity has been detected during the 25-year follow up period. The PSF group had a small but statistically significant higher score in the Satisfaction domain compared to the braced group. TRIAL REGISTRATION: S-20110025 Regional Committees on Health Research Ethics for Southern Denmark.

[Severe constipation caused by an abnormally angled coccyx]. / Svær obstipationsom følge af abnormt vinklet os coccygis

Constipation is a common disease among patients in all age groups, and the pathology can vary. This case report describes a 26-year-old female with severe constipation for six years. She was referred to a centre for spine surgery with a coccyx compressing her rectum causing constipation. The symptoms developed six years previously after a trauma, progressed during pregnancy and after giving birth. X-ray showed a 90-degree anterior angulated coccyx compressing the rectum. She was treated with resection of the coccyx, and symptoms disappeared after surgery.

Pain reduction after percutaneous vertebroplasty for myeloma-associated vertebral fractures.

INTRODUCTION: Percutaneous vertebroplasty (PVP) is a minimally invasive procedure with cement augmentation of vertebral fractures. It was introduced in 1987 as a treatment for painful haemangiomas and is today mostly used for painful osteoporotic fractures of the spine. Two randomised, double-blinded trials published in 2009 have raised a debate about the efficiency of the PVP treatment. The aim of this study was to assess the safety and efficacy of PVP for vertebral body fractures in myeloma patients. METHODS: A consecutive group of patients with multiple myeloma who underwent PVP were reviewed. A total of 64 levels were treated on 17 patients during 24 sessions. All procedures were performed in local anaesthesia; no patients complained about discomfort during the procedure. RESULTS: The median preoperative visual analogue scale (VAS) score was 7.6. Improvement was observed in all patients. The median VAS pain score decreased to 3.2 at the three-month follow-up. The results are statistically significant. No complications were observed either during or after the treatment. We observed cement leakage in 12.5% of the patients, but no patients with cement leakage had clinical symptoms. CONCLUSION: PVP is a safe and efficient procedure in the treatment of painful vertebral fractures in patients with multiple myeloma. The main advantages are the immediate stabilisation of the fractured vertebral body, reduction of the pain level and the fact that the patient can be discharged after two hours. The procedure can be repeated for several levels, and the pain relieving effect seems to be permanent. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.