The Impact on Life questionnaire: validation for elective surgery prioritisation in New Zealand prioritisation criteria in orthopaedic surgery.

AIM: This cohort study tested the reliability and validity of the Impact on Life (IoL) patient-rated questionnaire for use in prioritising orthopaedic procedures. METHODS: Three hundred and twenty-four patients completed the questionnaire during specialist orthopaedic assessments over a 5-month period in 2013. The reliability and validity of the IoL were tested against the SF-12 and Oxford scores. Correlation analysis was used to assess patient- and surgeon-rated scores. Internal consistency reliability was assessed using Cronbach's alpha. Patient- and surgeon-rated scores were further analysed between patients added to the waiting list and those that were not. RESULTS: Participants' mean age was 58 years (range 18-88). Reliability analysis showed the IoL had excellent internal consistency with a Cronbach's alpha of 0.926, reaching the threshold for clinical application. Construct validity of the IoL was confirmed with significant correlation with other validated quality of life measures (p<0.01). T-tests indicated that patients placed on the waiting list had significantly higher surgeon and IoL scores (p<0.001), compared with those not placed on the waiting list. CONCLUSION: Our results support the IoL as a valid and reliable method of assessing patient-rated quality of life and recommend its use in the Orthopaedic Clinical Priority Assessment Criteria score.

Impact of surgical waiting time on paediatric spinal deformity patients.

BACKGROUND: Scoliosis has been shown to affect quality of life of young people. There can be a lengthy wait for surgery. We aim to assess whether the length of time waiting for surgery has an impact on quality of life and surgical outcomes. METHODS: Patients who were waiting for or had completed surgery for paediatric spinal deformity in the last 3 years were contacted and asked to complete the Scoliosis Research Society-30 (SRS-30) questionnaire as well as a questionnaire designed to specifically assess the impact of waiting for surgery. Hospital records and X-rays were reviewed to determine surgical outcomes. RESULTS: Longer waiting time was associated with both lower SRS scores (0.13 points per 6 months, P = 0.01) and lower wait time questionnaire values (0.12 points per 6 months, P < 0.01). Within the SRS-30 questionnaire, pain, satisfaction with management and self-image domains showed a statistically significant decrease with increasing wait time (P = 0.02, 0.05, >0.01 respectively). Cobb angles progressed with increased waiting time, but progression was not statistically significant. No correlation was found between waiting times and the other surgical outcomes measured (surgical duration, hospital stay, blood transfusion, return to theatre or other complications). CONCLUSION: Increased waiting time for surgery has a negative impact on quality of life of patients with scoliosis.

Prevalence of triangular fibrocartilage complex abnormalities on MRI scans of asymptomatic wrists.

PURPOSE: Magnetic resonance imaging (MRI) of the wrist is increasingly used in the diagnosis of ulnar-sided wrist pain; however, its efficacy in this setting still needs clarification. The purposes of this study were to investigate the prevalence of abnormal MRI findings in the triangular fibrocartilage complex (TFCC) in asymptomatic volunteers and to provide the clinician with comparative data when interpreting MRI results. METHODS: A total of 103 asymptomatic volunteers underwent imaging of the wrist using a 1.9-T MR scanner and a send-receive birdcage quadrature coil. The images were evaluated by 3 independent interpreters, 2 musculoskeletal radiologists, and 1 orthopedic hand surgeon. We noted details regarding the TFCC morphology and the presence, characteristics, and location of any TFCC abnormality. RESULTS: The TFCC was considered abnormal in 39 wrists. The scans were abnormal in 31 subjects younger than 50 years of age, in 5 subjects 50 to 59 years of age, and in all subjects older than 60 years of age (3 subjects). We diagnosed a complete tear of the TFCC in 23 wrists. An increase in age was correlated with an abnormal TFCC (r(pb) = 0.23; P = .016). CONCLUSIONS: The prevalence of incidental TFCC findings in MRI scans of asymptomatic subjects is high. The presence of an abnormal TFCC on MRI may be of questionable clinical meaning, because there is a high incidence of TFCC abnormalities in asymptomatic subjects, particularly those over the age of 50. Imaging results must be viewed in the context of the clinical history and physical examination. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.

Lumbosacral nerve root anomaly associated with spondylolisthesis in an adolescent: a case report and review of the literature.

STUDY DESIGN: Case report. OBJECTIVE: We describe the case of a lumbosacral nerve root anomaly in a 16-year-old male with spondylolisthesis and neurologic findings exceeding that that was expected of the underlying deformity. A complete review of clinical, radiologic, and operative records was performed. SUMMARY OF BACKGROUND DATA: Spondylolisthesis is a relatively common cause of lower back pain in adolescents. Neurologic findings may occur, most commonly associated with higher grade spondylolisthesis and spondyloptosis. Lumbosacral nerve root anomalies have been reported and are typically associated with neurologic symptoms in excess of the underlying deformity. METHODS: The 16-year-old male presented with lower back pain, difficulty walking, and sensory and motor symptoms in the L5 and S1 nerve root distributions. Radiographs revealed a Meyerding grade III spondylolisthesis, with a slip angle of 14 degrees and a lumbosacral angle of 76 degrees . Neither computerized tomography nor magnetic resonance imaging revealed the presence of lumbosacral nerve root anomalies. RESULTS: Intraoperatively, an L5-S1 anastomotic nerve root on the left side was identified. CONCLUSIONS: This case emphasizes the need to consider the presence of lumbosacral nerve root anomalies in cases in which neurologic findings exceed what would be anticipated. Preoperative identification of these anomalies allows for their existence to be considered in the surgical plan.