Sagittal profile control in patients affected by neurological scoliosis using Universal Clamps: a 4-year follow-up study

Abstract

Patients affected by cerebral palsy often develop progressive scoliosis that can results in trunk instability with an impairment of both coronal and sagittal balance. The aim of this retrospective study was to demonstrate the ability of UC to control the sagittal profile in a consecutive series of patients affected by neurological scoliosis. From 2006 to 2008, 84 patients (57 F, 27 M) affected by neurological scoliosis were treated surgically. Mean age was 14 years (range 10-17). The etiology was mainly cerebral palsy. The average pre-operative Cobb angle was 73° ± 16°. Patients were divided into three groups according to the pre-operative presence of: physiological kyphosis (mean 29° ± 8°), thoracic lordosis (mean 10° ± 6°) and hyperkyphosis (51° ± 8°). A posterior access was performed in all patients using thoracic UC associated with transpedicular lumbar screws and a conventional claw at the upper extremity of the construct. The average percentage of coronal correction was 72%. In all three groups, we observed a common trend toward maintaining or restoring the physiological values. Mean follow-up time was 36 months. At the 1-year follow-up, the mean loss of correction was 7° ± 2° in the coronal plane and 2° ± 1° in the sagittal plane with no other change thereafter. The hybrid construct using UC appears effective in neurological scoliosis treatment, providing a good correction of the deformity in both coronal and sagittal planes. In the present series, physiological thoracic kyphosis has been restored in all patients, providing better sitting tolerance in wheelchair-bound patients, and retaining standing and walking abilities in ambulatory patients.