Assessment of skeletal age is important in children’s orthopaedics. We compared two simplified methods used in the assessment of skeletal age. Both methods have been described previously with one based on the appearance of the epiphysis at the olecranon and the other on the digital epiphyses. We also investigated the influence of assessor experience on applying these two methods.

Our investigation was based on the anteroposterior left hand and lateral elbow radiographs of 44 boys (mean: 14.4; 12.4 to 16.1 ) and 78 girls (mean: 13.0; 11.1 to14.9) obtained during the pubertal growth spurt. A total of nine observers examined the radiographs with the observers assigned to three groups based on their experience (experienced, intermediate and novice). These raters were required to determined skeletal ages twice at six-week intervals. The correlation between the two methods was determined per assessment and per observer groups. Interclass correlation coefficients (ICC) evaluated the reproducibility of the two methods.

The overall correlation between the two methods was r = 0.83 for boys and r = 0.84 for girls. The correlation was equal between first and second assessment, and between the observer groups (r ≥ 0.82). There was an equally strong ICC for the assessment effect (ICC ≤ 0.4%) and observer effect (ICC ≤ 3%) for each method. There was no significant (p < 0.05) difference between the levels of experience.

The two methods are equally reliable in assessing skeletal maturity. The olecranon method offers detailed information during the pubertal growth spurt, while the digital method is as accurate but less detailed, making it more useful after the pubertal growth spurt once the olecranon has ossified.

Cite this article: Bone Joint J 2014;3:1556–60

Introduction

Surgical treatment of spinal metastasis belongs to the standards of oncology. The risk of spinal cord compression represents an operative indication. Intraoperative bleeding may vary, depending on the extent of the surgical technique. Some primary tumors, such as the renal cell carcinoma, present a major risk for hemorrhage and preoperative embolisation is mandatory. The purpose of this study is to evaluate the possible benefit of embolisation in different types of primary tumors.

Purpose of the study: The in situ contournage technique can be used to correct the 3D spinal deformity resulting from scoliosis; the manoeuvres enable rotational corrections, medialisation, and kyphosis and lordosis of strategic segments of the spine. A preliminary study identified a prolonged zone of thoracolumbar sagittal rectitude in thoracic, double major and lumbar scoliosis, indicating the vertebrae with the maximal rotation and the zones of hypokyphosis and hypolordosis. The purpose of the present study was to analyse the correction and sagittal balance of these segments after in situ contournage.

Material and methods: The pre- and postoperative radiographs of 54 patients (48 female, 6 male, mean age 21 years, mean follow-up 8 years) with idiopathic scoliosis (36–104) were analysed with Spineview. The types of curvatures, the levels included in the sagittal rectitude and the vertebrae with the maximal rotation were determined. The kyphosis was measured on T4-T12, T4-T8 and T9-T12. Lordosis was measured on L1-S1, T12-L2, L3-S1. Tilt on T1 and T9 and sacral slop as well as pelvic version and incidence were determined.

Results: Three characteristic configurations were analysed: thoracic curvature with sagittal rectitude T8-L1 and maximal rotation at T7-T8, double major curvatures with sagittal rectitude T9-L2 and maximal rotation at T8-T9 and L2-L3, and lumbar curvatures with sagittal rectitude T12-L4 and maximal rotation at L1-L2. After posterior instrumentation, the T4-T12 hyperkyphosis decreased on average from 24.1 to 17.4° (p=0.0001) and the T9-T12 hypokyphosis increased from 3.6 to 8.6° (p=0.0001) for the thoracic and double major curvatures. The T12-L2 hyperlordosis increased from 6.6 to 10.3° (p=0.027) and the L3-S1 lordosis decreased from 42.1 to 38.9° (p=0.463) in the lumbar and double major curvatures. Tilts, sacral slope, and pelvic version and incidence did not vary significantly.

Conclusion: The prolonged thoracolumbar sagittal rectitude exhibits three distinctive configurations. Each configuration indicates the level of maximal rotation at the superior or inferior end. It enables a decomposition of the overall thoracic kyphosis into a superior segment of hyperkyphosis and an inferior segment of hypokphosis and to identify a zone of superior lumbar hypolordosis. In situ contournage corrects the vertebral rotation, the kyphosis and the lordosis and acts on the strategic vertebrae. The rectitude can be used to better identify the zones requiring correction in order to optimise the balance between the thoracic kyphosis and the lumbar lordosis while improving vertebral rotation by traction or compression.

Purpose of the study: Prolongation of the phyisiological sagittal rectitude of the thoracolumbar junction (T11-T1) is often observed in thoracic, double major and lumbar idiopathic scoliosis. The purpose of this study was to check the potential relationship between vertebral rotation, type of curvature in the frontal plane, and the observation of sagittal rectitude exceeding four vertebrae.

Material and methods: The preoperative radiographs of 54 patients (48 female, 6 male, mean age 21 years) with idiopathic scoliosis were analysed with Spineview. The type of curvature: thoracic, double major or lumbar (Lenke 1, 3 or 5) and the Cobb angles were noted. The levels included in the zone of sagittal rectitude, the thoracic kyphosis, the lumbar lordosis, the sacral slope, the pelvic incidence and version, the T1 to T9 tilts were noted on the lateral view. Vertebral rotation was analysed for all thoracic and lumbar vertebrae using the method described by Perdriolle, Nash and Moe on the anteroposterior radiographs. The axial rotation was measured on the scanner.

Results: Curvatures ranged from 36 to 104° (mean 59°). Fifty-two patients had a flat or concave back. Mean T1 tilt was 3°; it was 6° at T9. The pelvic incidence was 49°, the sacral slope 40°, the pelvic version 9°. The detailed analysis demonstrated zones of inferior thoracic hypokyphosis, and superior lumbar hypolordosis resulting in sagittal rectitude (5–7 vertebrae). The maximal vertebral rotation was situated at the superior part of the hypokyphosis or the inferior part of the hypolordosis. Three configurations were identified: 27 thoracic curvatures (Lenke 1) with cranial prolongation of the sagittal rectitude (T8-L1) and maximal rotation at T7-T8; 21 double major curvatures (Lenke 3 with cranial and caudal prolongation (T9-L2 and maximal rotation at T8-T9 and L2-L3 respectively; and 6 lumbar curvatures (Lenke 5) with caudal prolongation (T12-L4) and maximal rotation at L1-L2.

Conclusion: Thoracolumbar sagittal rectitude can be prolonged with three geometric configurations related to the type of thoracic, double major and lumbar curvatures. This zone of rectitude indicates the level of the maximal vertebral rotation at is superior or inferior extremity. It also reflects the zones of segmental hyperkyphosis and hypolordosis that need to be corrected during the surgical treatment of the scoliosis.