Long-term Outcome in Neuromuscular Scoliosis Fused Only to Lumbar 5

Abstract

Outcomes are retrospectively compared for patients with neuromuscular scoliosis after instrumented surgery and fusion to the pelvis versus lumbar 5 fusion alone. To compare outcomes for patients with neuromuscular scoliosis for correction of scoliosis, lumbar 5 tilt, and pelvic obliquity after instrumented surgery and pelvic fusion, and by fusion only to lumbar 5. Correction of scoliosis and pelvic obliquity in neuromuscular disease using spinal instrumentation is an accepted surgical procedure. Controversy remains concerning the caudal extent of fusion and instrumentation to lumbar 5 or to the sacrum. Patients with progressive neuromuscular scoliosis underwent spinal fusion with segmental instrumentation using a U-rod terminating in pedicle screw fixation at L5. Similar patients underwent spinal fusion with a unit rod and sacral fusion. From 1998 to 2002, 55 patients with neuromuscular scoliosis underwent instrumentation and L5 fusion with the U-rod or to the sacrum with the unit rod. Initial and long-term corrections of scoliosis and pelvic obliquity were similar in both groups. Instrumentation and fusion to L5 is a less technically difficult procedure, requires less surgical time, has decreased blood loss, and less risk of infection compared to instrumented pelvic fusion. Postoperative and long-term follow-up indicates that L5 fusion can correct scoliosis and pelvic obliquity, comparable to results of sacrum fusion.