Anesthesia for cesarean section for achondroplastic dwarf: a case report

This case report discusses the preanesthesia plan, actual anesthesia administration, and the postanesthesia course involving a gravid achondroplastic dwarf. The need for discussion of all anesthesia options when planning the anesthesia care associated with uncommon disorders and pregnancy is illustrated.

Do radiographic parameters correlate with clinical outcomes in adolescent idiopathic scoliosis?

STUDY DESIGN

A radiographic assessment has been developed to include coronal, sagittal, and axial parameters.

OBJECTIVE

To determine the correlation of postoperative radiographic results and percentage postoperative radiographic improvement with patient clinical self-assessment.

SUMMARY OF BACKGROUND DATA

With the increasing interest in outcome studies, the authors wanted to determine whether Scoliosis Research Society clinical questionnaire results would correlate with objective radiographic improvement.

METHODS

INCLUSION CRITERIA

adolescent idiopathic scoliosis treated with anterior or posterior instrumentation, a solid fusion, minimum 2-year follow-up, and a completed postoperative Scoliosis Research Society questionnaire. Seventy-eight patients met the criteria. Measurements included in the radiographic score: Cobb angles of the coronal curve, C7 to the center sacral vertical line, apical translation, apical vertebral rotation, T1 rib angle, end-instrumented vertebrae angulation, angulation of the disc below the end-instrumented vertebra, and curve type. Sagittal measurements included T2-T12, T5-T12, T2-T5, T12-L2, and L1-S1.

RESULTS

The preoperative radiographic score of these 78 patients was mean 60.1 +/- 9.7 (range 41-88, maximum radiographic score, 100). The 2-year postoperative radiographic score was mean 83.8 +/- 8.8 (range, 65-100). The median Scoliosis Research Society questionnaire score was 98 +/- 12.3 (range, 58-116, maximum score, 125, showing that the patient is highly satisfied and asymptomatic). The postoperative radiographic score versus the questionnaire score showed a Spearman rank correlation of 0.04 (P = 0.68, little or no correlation throughout). Percentage improvement of the radiographic score versus the questionnaire score showed a Spearman rank correlation of 0.1 (P = 0.38, little or no correlation throughout).

CONCLUSION

In this initial group of patients, the radiographic assessment shows a significant improvement between preoperative and 2-year postoperative scores. However, little correlation between the radiographic assessment and the questionnaire scores was found in this adolescent population, suggesting that separate analyses of radiographic and clinical outcome data are required when evaluating results of postoperative scoliosis surgery.