Abstract
The objective of this investigation was to determine the outcome of spine fusion for neuromuscular (NM) scoliosis, using Unit Rod technique, with emphasis on complications related to preoperative general health. Between 1997 and 2007, 96 consecutive patients with neuromuscular scoliosis operated on with Unit Rod instrumentation were retrospectively reviewed. The inclusion criteria were diagnosis of NM scoliosis due to cerebral palsy (CP) and muscular dystrophy (DMD). Patient's preoperative general health, weight, and nutrition were collected. Different radiographic and clinical parameters were evaluated. There were 66 CP patients (59 nonwalking) and 30 DMD patients (24 nonwalking). Mean age at surgery was 16.5 years and 13.9 years, respectively. All radiographic measurements improved significantly. Wound infection rate was 16.7% (11% of reoperation rate in CP; 10% in DMD; 3 hardware removal cases). No pelvic fracture due to rod irritation was observed. Unit Rod technique provides good radiographic and clinical outcomes even if this surgery is associated with a high complication rate. It is a quick, simple, and reliable technique. Perioperative management strategy should decrease postoperative complications and increases outcome. A standardized preoperative patient evaluation and preparation including respiratory capacity and nutritional, digestive, and musculoskeletal status are mandatory prior to surgery.
Highlights
Patients with neuromuscular diseases frequently develop scoliosis that requires surgical correction [1,2,3]
Patients with neuromuscular scoliosis undergoing posterior spinal fusion are at higher risk for postoperative complications due to underlying comorbidities [14,15,16] such as decreased pulmonary function, inadequate nutritional status, decreased mobility, and cognitive impairment
Complication rate associated with spinal surgery in neuromuscular scoliosis ranges from 17% to 74% [14, 16,17,18,19,20,21,22,23,24]
Summary
Patients with neuromuscular diseases frequently develop scoliosis that requires surgical correction [1,2,3]. Spinal deformity is associated with great pelvic obliquity. Extension into the pelvis is meant to achieve global correction of both pelvic and spinal deformity [4,5,6,7,8,9,10]. A lot of instrumentation has been used in these specific deformities but the use of techniques such as the one described by Luque and Galveston remains the gold standard [10,11,12,13] with low complication rate related to the material, short operation time, and good functional results. Patients with neuromuscular scoliosis undergoing posterior spinal fusion are at higher risk for postoperative complications due to underlying comorbidities [14,15,16] such as decreased pulmonary function, inadequate nutritional status, decreased mobility, and cognitive impairment. Few studies pointed out the relation between postoperative complications and preoperative nutritional, digestive, and respiratory preparation of patients
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