title: A survey of current controversies in scoliosis surgery in the United Kingdom.
abstract: METHODS
  A 10-point questionnaire was constructed to identify the philosophy of surgeons on various aspects of scoliosis surgery, such as choice of implant, bone graft, autologous blood transfusion, cord monitoring, and computer-assisted surgery. Comparisons were then made with recommendations published in the spinal literature.
  
  
  OBJECTIVE
  To determine certain aspects of the current practice of scoliosis surgery in the United Kingdom.
  
  
  BACKGROUND
  Guidelines for good clinical practice in spinal deformity surgery are available in the United Kingdom but do not cover a number of controversial issues.
  
  
  METHODS
  Consultants and fellows attended the 2009 British Scoliosis Society meeting. Fifty questionnaires were completed by 45 consultants and 5 fellows.
  
  
  RESULTS
  All pedicle screw constructs favored by 25 of 50, hybrid 24 of 50 (1 undecided). Posterior construct of fewer than 10 levels, 20 of 50 would not cross-link, 11 of 50 used 1, and 19 of 20 used 2 or more. More than 10 levels 17 of 50 considered cross-links unnecessary, 4 of 50 used 1 and 29 of 50 used 2 or more. Eighty-eight percent preferred titanium alloy implants, whereas others used a mixture of stainless steel and cobalt chrome. When using bone graft, respondents used bone substitutes (24), iliac crest graft (14), allograft (12) and demineralized bone matrix (9) in addition to local bone. Ten of 50 would use recombinant bone morphogenetic protein (3 for revision cases only). Thirty-nine of 50 routinely used intraoperative cell salvage and 4 of 50 never used autologous blood. All used cord monitoring: sensory (19 of 50), motor (2 of 50), and combined (29 of 50). None used computer-aided surgery. Twenty-six operated alone, 12 operated in pairs, and 12 varied depending on type of case.
  
  
  CONCLUSIONS
  This survey shows interesting variations in scoliosis surgery in the United Kingdom. It may reflect the conflicting evidence in the literature.
authors.affiliation: Sheffield Children's Hospital and the Northern General Hospital, Sheffield, UK.
authors.forename: Anthony L R
authors.initials: AL
authors.lastname: Michael
authors.forename: Peter R
authors.initials: PR
authors.lastname: Loughenbury
authors.forename: Abhay S
authors.initials: AS
authors.lastname: Rao
authors.forename: Robert A
authors.initials: RA
authors.lastname: Dunsmuir
authors.forename: Peter A
authors.initials: PA
authors.lastname: Millner
mesh_terms: D001863:Bone Screws / Q000706:statistics & numerical data; D016025:Bone Transplantation / Q000706:statistics & numerical data; D006801:Humans; D016268:Internal Fixators / Q000706:statistics & numerical data; D011364:Professional Practice / Q000706:statistics & numerical data; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods* / Q000706:statistics & numerical data; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D006113:United Kingdom