Abstract
BackgroundTo determine whether posterior-only approach using pedicle screws in neuromuscular scoliosis population adequately addresses the correction of scoliosis and maintains the correction over time.MethodsBetween 2003 and 2006, 26 consecutive patients (7 cerebral palsy, 10 Duchenne muscular dystrophy, 5 spinal muscular atrophy and 4 others) with neuromuscular scoliosis underwent posterior pedicle screw fixation for the deformity. Preoperative, immediate postoperative and final follow-up Cobb's angle and pelvic obliquity were analyzed on radiographs. The average age of the patients was 17.5 years (range, 8–44 years) and the average follow-up was 25 months (18–52 months).ResultsAverage Cobb's angle was 78.53° before surgery, 30.70° after surgery (60.9% correction), and 33.06° at final follow-up (57.9% correction) showing significant correction (p < 0.0001). There were 9 patients with curves more than 90° showed an average pre-operative, post operative and final follow up Cobb's angle 105.67°, 52.33° (50.47% correction) and 53.33° (49.53% correction) respectively and 17 patients with curve less than 90° showed average per operative, post operative and final follow up Cobb's angle 64.18, 19.24(70% correction) and 21.41(66.64 correction); which suggests statistically no significant difference in both groups (p = 0.1284). 7 patients underwent Posterior vertebral column resection due to the presence of a rigid curve. The average spinal-pelvic obliquity was 16.27° before surgery, 8.96° after surgery, and 9.27° at final follow-up exhibited significant correction (p < 0.0001). There was 1 poliomyelitis patient who had power grade 3 in lower limbs pre-operatively, developed grade 2 power post-operatively and gradually improved to the pre-operative stage. There was 1 case of deep wound infection and no case of pseud-arthrosis, instrument failures or mortality.ConclusionResults indicate that in patients with neuromuscular scoliosis, acceptable amounts of curve correction can be achieved and maintained with posterior-only pedicle screw instrumentation without anterior release procedure.
Highlights
To determine whether posterior-only approach using pedicle screws in neuromuscular scoliosis population adequately addresses the correction of scoliosis and maintains the correction over time
The prevalence of severe spinal deformity in patients with neuromuscular disorders is estimated between 50% and
Postoperative and final follow-up Cobb's angle, pelvic obliquity, thoracic kyphosis and lumbar lordosis are shown in table 2
Summary
To determine whether posterior-only approach using pedicle screws in neuromuscular scoliosis population adequately addresses the correction of scoliosis and maintains the correction over time. The use of hooks in the thoracic spine has been considered as a gold standard for the treatment of neuromuscular scoliosis. There has been a movement toward the use of thoracic pedicle screws in deformity surgery, based on the reports regarding clinical advantages of pedicle screw fixation in the lumbar spine in terms of enhanced correction and stabilization, when compared with a hook construct [5,16,17]. Uses of Luque rods or unit rod instrumentation have their own disadvantages such as loosening of wires, cutting out of wires, loss of fixation and loss of correction over time and in addition, delayed sitting and ambulation in post-operative phase
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
