ABSTRACT
Lateral flexion-extension radiographs of 72 patients with Down syndrome were used to assess the interobserver reliability and intraobserver reproducibility of the atlanto-dens interval, Wiesel-Rothman measurement, occiput atlas angle, and Power's ratio in flexion and extension. The radiographs were reviewed by three blinded observers on three different occasions with at least a 1-month interval between assessments. The intraclass correlation coefficient was used to measure the reproducibility of the measurements from a given observer and the reliability between different observers. With the exception of observer one, the atlanto-dens interval had a statistically significant intraobserver agreement compared with any of the other measurements (p < 0.05). The atlanto-dens interval and the Wiesel-Rothman measurements tended to have better correlation between observers, although there was only fair agreement. The agreement, however, was statistically significant (p < 0.05) compared with Power's ratio. The degree of intraobserver reproducibility and interobserver reliability may make it difficult to base treatment protocols on these measurements.
Subject(s)
Cervical Vertebrae/pathology , Down Syndrome/pathology , Adolescent , Cervical Vertebrae/diagnostic imaging , Child , Child, Preschool , Down Syndrome/diagnostic imaging , Humans , Observer Variation , Radiography , Reproducibility of ResultsABSTRACT
STUDY DESIGN: A case report of late complication after single-rod instrumentation. OBJECTIVES: To report a case of symptomatic, perispinal, soft-tissue complication after successful fusion of a scoliotic curve using a unilateral, posterior, multiple hook-rod construct. SUMMARY OF BACKGROUND DATA: Delayed perispinal soft-tissue complications recently have been observed with two-rod, multihook system constructs. The etiology is believed to be low, virulence bacteria causing delayed infection, or metal fretting causing chronic inflammation. This phenomenon has not been linked to single-rod constructs. METHODS: The observation of perispinal soft-tissue inflammation was made during exploratory surgery for progressive pain overlying the rod. The diagnosis was supported by laboratory findings. RESULTS: Complete pain relief was obtained after removal of the hardware and empiric treatment with an oral antibiotic. CONCLUSIONS: Delayed chronic inflammation may occur as a late complication of the use of a unilateral, posterior, multiple hook-rod construct in the spine. This problem can be managed successfully with hardware removal, and, because the etiology of this type of inflammation is unclear, infection with a low virulence organism should be considered.
