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Moreno Mateo F, Heyer JH, Gmelich C, Page K, Cirrincione P, Adhiyaman A, Tracey OC, Widmann RF. Four-rod technique for neuromuscular scoliosis and pelvic obliquity correction: technical note and case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2025; 35:109. [PMID: 40069430 DOI: 10.1007/s00590-025-04217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 02/19/2025] [Indexed: 05/13/2025]
Abstract
Surgical correction of neuromuscular scoliosis is a challenging problem facing spine surgeons. Many patients require long constructs and pelvic fixation to obtain adequate curve correction and pelvic obliquity correction. The aim of this technical note is to describe a technique for sequential pelvic obliquity and scoliotic curve correction in patients with neuromuscular scoliosis using four rods in upper thoracic to pelvis posterior spinal fusion, without the need for intraoperative traction. We present 5 cases of neuromuscular scoliosis that underwent upper thoracic to pelvis posterior spinal fusion using the four-rod technique and demonstrate improvement in major Cobb angle and pelvic obliquity immediately postoperatively and maintained at final follow-up (range: 2-16 years). Preliminary findings from this small case series support the use of four-rod correction technique for correction of neuromuscular scoliosis and pelvic obliquity.
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Affiliation(s)
- Fernando Moreno Mateo
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Jessica H Heyer
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Caroline Gmelich
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Kira Page
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Peter Cirrincione
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Akshitha Adhiyaman
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Olivia C Tracey
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Roger F Widmann
- Department of Pediatric Orthopaedics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Ouchida J, Nakashima H, Ohara T, Machino M, Ito S, Segi N, Yamauchi I, Imagama S. Patterns of sitting spinal alignment in non-ambulatory scoliosis patients with paraplegia: an observational study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2025; 34:556-564. [PMID: 39611971 DOI: 10.1007/s00586-024-08584-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 10/17/2024] [Accepted: 11/22/2024] [Indexed: 11/30/2024]
Abstract
PURPOSE To classify sagittal spinopelvic alignment patterns of non-ambulatory scoliosis patients with paraplegia based on lateral sitting radiographs and explore their relation to clinical background and physical function. METHODS We reviewed non-ambulatory scoliosis patients with paraplegia, excluding those with prior spinal surgery from a single-center database. Alignment patterns in sitting postures were classified into slump sitting (SS) and erect sitting (ES) based on the most posterior edge of the spine's location on lateral sitting radiographs. Radiographical spinopelvic sagittal alignment, demographics, and physical functions were analyzed. Clinical scoring for physical functions included Hoffer's ambulator classification, Hoffer's modified sitting classification, and the Modified Ashworth Score (MAS) for the severity of spasticity in the lower extremities. Percentages of patients without spasticity, with MAS of 0 indicating "no spasticity." were also compared between the two alignment patterns. RESULTS Of 172 patients screened, 86 met inclusion criteria, revealing two distinct alignment patterns: SS showed greater thoracic kyphosis, smaller lumbar lordosis, pelvic retroversion, and hip hyperflexion compared to ES. No significant differences in demographic data or curve patterns were observed between groups. The SS group had a significantly higher percentage of patients without spasticity compared to the ES group (39.2% vs. 14.3%, P = 0.016). CONCLUSION Identified were two distinct sagittal alignment patterns in seated scoliosis patients with paraplegia, with potential influences from spasticity in the lower extremities. Recognizing these patterns can aid in assessing the function of sitting balance that includes the hip joint and in optimizing strategies for the treatment of scoliosis patients with paraplegia.
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Affiliation(s)
- Jun Ouchida
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan.
| | - Tetsuya Ohara
- Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan
| | - Masaaki Machino
- Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan
| | - Sadayuki Ito
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Naoki Segi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Ippei Yamauchi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
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Strom SF, Hess MC, Jardaly AH, Conklin MJ, Gilbert SR. Is it necessary to fuse to the pelvis when correcting scoliosis in cerebral palsy? World J Orthop 2022; 13:365-372. [PMID: 35582151 PMCID: PMC9048500 DOI: 10.5312/wjo.v13.i4.365] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/30/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neuromuscular scoliosis is commonly associated with a large pelvic obliquity. Scoliosis in children with cerebral palsy is most commonly managed with posterior spinal instrumentation and fusion. While consensus is reached regarding the proximal starting point of fusion, controversy exists as to whether the distal level of spinal fusion should include the pelvis to correct the pelvic obliquity.
AIM To assess the role of pelvic fusion in posterior spinal instrumentation and fusion, particularly it impact on pelvic obliquity correction, and to assess if the rate of complications differed as a function of pelvic fusion.
METHODS This was a retrospective, cohort study in which we reviewed the medical records of children with cerebral palsy scoliosis treated with posterior instrumentation and fusion at a single institution. Minimum follow-up was six months. Patients were stratified into two groups: Those who were fused to the pelvis and those fused to L4/L5. The major outcomes were complications and radiographic parameters. The former were stratified into major and minor complications, and the latter consisted of preoperative and final Cobb angles, L5-S1 tilt and pelvic obliquity.
RESULTS The study included 47 patients. The correction of the L5 tilt was 60% in patients fused to the pelvis and 67% in patients fused to L4/L5 (P = 0.22). The pelvic obliquity was corrected by 43% and 36% in each group, respectively (P = 0.12). Regarding complications, patients fused to the pelvis had more total complications as compared to the other group (63.0% vs 30%, respectively, P = 0.025). After adjusting for differences in radiographic parameters (lumbar curve, L5 tilt, and pelvic obliquity), these patients had a 79% increased chance of developing complications (Relative risk = 1.79; 95%CI: 1.011-3.41).
CONCLUSION Including the pelvis in the distal level of fusion for cerebral palsy scoliosis places patients at an increased risk of postoperative complications. The added value that pelvic fusion offers in terms of correcting pelvic obliquity is not clear, as these patients had similar percent correction of their pelvic obliquity and L5 tilt compared to children whose fusion was stopped at L4/L5. Therefore, in a select patient population, spinal fusion can be stopped at the distal lumbar levels without adversely affecting the surgical outcomes.
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Affiliation(s)
- Shane F Strom
- Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, Al 35294, United States
| | - Matthew C Hess
- Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, Al 35294, United States
| | - Achraf H Jardaly
- Department of Orthopaedics, The Hughston Clinic/Hughston Foundation, Columbus, GA 31908, United States
| | - Michael J Conklin
- Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, Al 35294, United States
| | - Shawn R Gilbert
- Department of Orthopaedics, University of Alabama at Birmingham, Birmingham, Al 35294, United States
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FALCÃO RODRIGOMAGALHÃES, RAMIRO KAIORODRIGOBARRETO, LIMA MAURICIOCOELHO, VEIGA IVANGUIDOLIN, RISSO NETO MARCELOITALO, LEHOCZKI MAURICIOANTONELLI, ROSSATO ALEXANDERJUNQUEIRA, CAVALI PAULOTADEUMAIA. PREVALENCE OF PJK AFTER ARTHRODESIS IN PATIENTS WITH NEUROMUSCULAR SCOLIOSIS IN THE SECOND POSTOPERATIVE YEAR. COLUNA/COLUMNA 2020. [DOI: 10.1590/s1808-185120201903224042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective The primary objective of this study was to analyze the prevalence of PJK in patients with neuromuscular scoliosis submitted to posterior spinal arthrodesis with instrumentation. Proximal junctional kyphosis (PJK) is a frequent phenomenon that, due to its importance, began to be studied by several authors, who laid the foundations for the radiographic definition and possible risk factors for its occurrence after long spinal arthrodesis with instrumentation. Despite the large number of PJK studies, most were related to the occurrence of adolescent idiopathic scoliosis, adult deformity and early-onset scoliosis, with few being targeted to patients with congenital and neuromuscular scoliosis. Methods In this study, data from electronic medical records of patients with neuromuscular scoliosis who underwent posterior arthrodesis with instrumentation between the years 2014 and 2016 were analyzed. Information on age, gender, pathology and radiographic measurements were extracted from this sample at the 2nd and 24th postoperative months. Results A total of 39 patients with neuromuscular scoliosis were analyzed. The sample was predominantly male (58.87%) and the mean age was 14.05 years. PJK occurred in 18 patients during the two years following surgery, with a prevalence of 46.15%. The incidence of PJK in the 2nd and 24th postoperative months was 23.1% and 30%, respectively. Conclusions A prevalence of PJK of 46.15% was found in patients with neuromuscular scoliosis treated surgically with posterior instrumentation after two years of follow-up, as compared to previous results . Level of Evidence III; Cross-sectional observational study.
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Affiliation(s)
- RODRIGO MAGALHÃES FALCÃO
- Universidade Estadual de Campinas, Brazil; Associação de Assistência à Criança Deficiente, Brazil
| | | | - MAURICIO COELHO LIMA
- Universidade Estadual de Campinas, Brazil; Associação de Assistência à Criança Deficiente, Brazil
| | - IVAN GUIDOLIN VEIGA
- Universidade Estadual de Campinas, Brazil; Associação de Assistência à Criança Deficiente, Brazil
| | | | | | | | - PAULO TADEU MAIA CAVALI
- Universidade Estadual de Campinas, Brazil; Associação de Assistência à Criança Deficiente, Brazil
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Abstract
PURPOSE Cerebral palsy (CP) is a disorder arising from a non-progressive lesion in the developing immature brain with an encephalopathy, that results in various levels of motor and sensory dysfunction. Motor disability of these children can be assessed by the Gross Motor Function Classification System in five levels, and depending on their motor functional capability, the most severely affected children fall into levels IV and V. Children in groups IV and V present a full spectrum of musculoskeletal deformities, among which, scoliosis is the most frequently found spinal deformity that most often requires surgical treatment. However, these are procedures that are usually technically demanding, requiring experienced surgical teams and a multidisciplinary approach. METHODS In order to overcome some of the technical pitfalls that may complicate these complex surgical procedures, the authors have gathered together different tips and tricks that may help surgeons performing surgical correction of spinal deformities in CP children. CONCLUSION Although for these children surgery is a major undertaking, with the multidisciplinary approach and advances of technology, anaesthesia and optimization of pre- and postoperative care, complications are manageable in most cases, improving not only the outcome of surgery but also the patient's quality of life and satisfaction of parents and caretakers.
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Affiliation(s)
- Jorge Mineiro
- Department of Orthopaedics and Traumatology, Orthopaedic Spine Unit, Hospital CUF Descobertas, Lisbon, Portugal,Paediatric Spine Unit, Hospital Dª Estefania, Lisbon, Portugal,Correspondence should be sent to Jorge Mineiro, Orthopaedic Department - Spine Unit, Hospital CUF Descobertas, Rua Mário Botas, Parque das Nações, 1998-018 Lisboa, Portugal. E-mail:
| | - Muharrem Yazici
- Department of Orthopaedics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Abstract
PURPOSE OF REVIEW Spinal deformity is a common issue in pediatric patients with an underlying neurological diagnosis or syndrome. Management of neuromuscular scoliosis (NMS) is a major part of the orthopedic care of such patients, as the deformity is often progressive, and may affect gait, seating and positioning. In addition, untreated large spinal deformities may be associated with pain and/or cardiopulmonary issues over time. RECENT FINDINGS Recent changes in medical management of the underlying disease process appears to alter the natural history of certain neuromuscular conditions, and in the case of patients with Duchenne's muscular dystrophy significantly diminish the incidence of spinal deformity. In the most common diagnosis associated with NMS, cerebral palsy, there is evidence that despite a high complication rate, surgical management of spinal deformity is associated with measurable improvements in validated health-related quality-of-life measures. Spinal deformity is a common finding in patients with neurological diagnoses. It is important for those involved in the care of these patients to understand the natural history of NMS, as well as the potential risks and benefits to the patient and caregivers, of surgical and non-surgical interventions.
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Affiliation(s)
- Robert F Murphy
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 708, MSC 622, Charleston, SC, 29425, USA.
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Segmental Pedicle Screw Instrumentation and Fusion Only to L5 in the Surgical Treatment of Flaccid Neuromuscular Scoliosis. Spine (Phila Pa 1976) 2018; 43:331-338. [PMID: 29095413 DOI: 10.1097/brs.0000000000000996] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective cohort study was performed. OBJECTIVE The purpose of this study was to determine the efficacy and safety of stopping segmental pedicle screw instrumentation constructs at L5 in the treatment of neuromuscular scoliosis. SUMMARY OF BACKGROUND DATA Duchenne muscular dystrophy and spinal muscular atrophy are flaccid neuromuscular disorders in which gradual deterioration is the hallmark and have a lot of characteristics in common despite differences in etiology. Instrumentation and fusion to the sacrum/pelvis has been a mainstay in the surgical treatment of flaccid neuromuscular scoliosis and recommended to correct pelvic obliquity. However, the caudal extent of instrumentation and fusion in the surgical treatment of flaccid neuromuscular scoliosis has remained a matter of considerable debate and there have been few studies on the use of segmental pedicle screw instrumentation for flaccid neuromuscular scoliosis. METHOD From 2005 to 2007, a total of 27 consecutive patients with neuromuscular disorders (20 Duchenne muscular dystrophy and 7 spinal muscular atrophy), aged 11 to 17 years, underwent segmental pedicle screw instrumentation and fusion only to L5. Assessment was performed clinically and with radiologic measurements. Minimum 2-year follow-up was required for inclusion in this study. RESULTS Twenty patients were enrolled in this study. No patient was lost to follow-up. All patients had L5 tilt of less than 15° and a coronal curve with apex L2 or higher preoperatively. Preoperative coronal curve averaged 70° (range: 51°-88°), with a postoperative mean of 15° (range: 5°-25°) and 17° (range: 6°-27°) at the last follow-up. The pelvic obliquity improved from 15° (range: 9°-25°) preoperatively to 5° (range: 3°-8°) postoperatively and 6° (range: 3°-8°) at the last follow-up. The L5 tilt improved from 9° (range: 2°-14°) preoperatively to 2° (range: 0°-4°) postoperatively and 2° (range: 0°-5°) at the last follow-up. Physiologic sagittal plane alignment was recreated after surgery and maintained long-term. There was no significant loss of correction of coronal curve and pelvic obliquity. There was no major complication. CONCLUSION Segmental pedicle screw instrumentation and fusion to L5 was safe and effective in patients with flaccid neuromuscular scoliosis with apex L2 or higher and minimal L5 tilt of less than 15°. Segmental pedicle screw instrumentation ending at L5 offered the ability to correct spinal deformity and pelvic obliquity initially, intermediate and even long-term, with no major complications. This method in appropriate patients can be a viable alternative to instrumentation and fusion to the sacrum/pelvis in the surgical treatment of flaccid neuromuscular scoliosis. LEVEL OF EVIDENCE N/A.
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Toovey R, Harvey A, Johnson M, Baker L, Williams K. Outcomes after scoliosis surgery for children with cerebral palsy: a systematic review. Dev Med Child Neurol 2017; 59:690-698. [PMID: 28262923 DOI: 10.1111/dmcn.13412] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2017] [Indexed: 11/29/2022]
Abstract
AIM This study aims (1) to evaluate and synthesize the evidence for the postoperative outcomes after scoliosis surgery for children with cerebral palsy (CP), and (2) to identify preoperative risk factors for adverse outcomes after surgery. METHOD Medline, EMBASE, CINAHL, and PubMed were searched for relevant literature. Included studies were assessed for risk of bias using the Cochrane Effective Practice and Organisation of Care tool. Quality of evidence for overall function, quality of life (QoL), gross motor function, caregiver outcomes, deformity correction, and postoperative complications were assessed using GRADE (Grades of Recommendation, Assessment, Development and Evaluation). RESULTS Fifty-one studies met inclusion criteria, including 35 case series designs. Risk of bias was high across all studies. On average good deformity correction was achieved, the trend appears positive for caregiver and QoL outcomes, but there was minimal to no change for gross motor or overall function. Inconsistent measurement limited synthesis. A mean overall complication rate of 38.1% (95% confidence interval 27.3-53.3) was found. The quality of evidence was very low across all functional outcomes. INTERPRETATION Limited high-quality evidence exists for outcomes after scoliosis surgery in children with CP, a procedure associated with a moderately high complication rate. The intervention appears indicated for deformity correction, but currently there is insufficient evidence to make recommendations for this surgery as a way to also improve functional outcomes, caregiver outcomes, and quality of life.
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Affiliation(s)
- Rachel Toovey
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Parkville, Vic., Australia
| | - Adrienne Harvey
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Developmental Medicine, The Royal Children's Hospital, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
| | - Michael Johnson
- Orthopaedic Surgery, The Royal Children's Hospital, Melbourne, Vic., Australia
| | - Louise Baker
- Developmental Medicine, The Royal Children's Hospital, Melbourne, Vic., Australia
| | - Katrina Williams
- Developmental Disability and Rehabilitation Research, Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Developmental Medicine, The Royal Children's Hospital, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
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Hyun SJ, Kim KJ, Jahng TA. S2 alar iliac screw placement under robotic guidance for adult spinal deformity patients: technical note. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:2198-2203. [DOI: 10.1007/s00586-017-5012-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 01/25/2017] [Accepted: 02/16/2017] [Indexed: 11/29/2022]
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Reoperation Rates After Long Posterior Spinal Fusion: Use of Recombinant Bone Morphogenetic Protein in Idiopathic and Non-idiopathic Scoliosis. Spine Deform 2016; 4:304-309. [PMID: 27927521 DOI: 10.1016/j.jspd.2015.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 12/12/2015] [Accepted: 12/24/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Bone morphogenetic protein (BMP) can increase the likelihood of solid arthrodesis in spinal surgery. This would imply fewer reoperations for pseudarthrosis, but small cohort sizes are inadequate to monitor these events. We sought to examine adolescent idiopathic (AIS) and non-idiopathic scoliosis (NIS) for reoperation events with and without the use of BMP using a large statewide database. METHODS The 2008-2011 New York State Inpatient Database was queried using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Patients age 10 and older with a diagnosis of scoliosis and an index fusion of greater than 2 spinal motion segments were included. Patient identifiers and linkage variables were used to identify revisits. The relative risk of reoperation was calculated. The use of BMP at the initial inpatient stay was used to define the two cohorts for relative risk assessment. RESULTS A total of 2,658 and 2,431 cases were identified of AIS and NIS, respectively. The use of BMP at the initial visit was performed at a rate of 4.5% for AIS and 21.0% for NIS fusion surgery. For posterior fusion cases longer than eight levels, the reoperation rate for pseudarthrosis was 1.0% in AIS and 18.4% in NIS (p < .001). For NIS fusions greater than eight levels, the rate of reoperation for pseudarthrosis after using BMP at the index surgery was 5% and 22% when BMP was not used, a relative risk of 4.0 (p < .001). For AIS, there was no substantial increase in risk when not using BMP for fusion greater than eight levels (p < .001). CONCLUSION We found a significant decrease in the risk of reoperation for pseudarthrosis after long fusions when using BMP in the case of NIS. In contrast, use of BMP does not benefit the AIS population.
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Suh DH, Hong JY, Suh SW, Park JW, Lee SH. Analysis of hip dysplasia and spinopelvic alignment in cerebral palsy. Spine J 2014; 14:2716-23. [PMID: 24662207 DOI: 10.1016/j.spinee.2014.03.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 11/30/2013] [Accepted: 03/16/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Knowledge of sagittal spinopelvic parameters and hip dysplasia is important in cerebral palsy (CP) patients because these parameters differ from those found in the general population and can be related to symptoms. PURPOSE The purpose of this study was to analyze sagittal spinopelvic alignment and determine its relation to hip dysplasia in CP patients. STUDY DESIGN Radiological analysis was conducted on patients with CP. PATIENT SAMPLE Fifty-four patients with CP and 24 normal controls were included in this study. OUTCOME MEASURES Participants underwent radiographs of the whole spine. METHODS The patient and control groups comprised 54 CP patients and 24 volunteers, respectively. All underwent lateral radiography of the whole spine and hip joint anteroposterior radiography. The radiographic parameters examined were sacral slope, pelvic tilt, pelvic incidence, S1 overhang, thoracic kyphosis, thoracolumbar kyphosis, lumbar lordosis, sagittal balance, center edge angle, acetabular angle, and migration index. Statistical analysis was performed to identify significant differences and correlations between the two groups. RESULTS Sacral slope, thoracolumbar kyphosis, lumbar lordosis, sagittal balance, acetabular angle, and migration index were significantly higher in CP patients, whereas pelvic tilt, S1 overhang, and center edge angle were significantly lower (p<.05). Correlation analysis revealed that pelvic incidence, sacral slope, pelvic tilt, and S1 overhang were related to each other and that thoracolumbar kyphosis was related to the thoracic kyphosis and lumbar lordosis (p<.05). For spinal and pelvic parameters, lumbar lordosis was related to sacral slope, pelvic incidence, pelvic tilt, and S1 overhang; for hip dysplasia parameters, center edge angle and acetabular angle were found to be interrelated (p<.05). Regarding symptoms, pelvic tilt, S1 overhang, and thoracolumbar kyphosis were found to be correlated with symptom severity in patients. However, no hip dysplasia parameters were found to be related to hip or spinal symptoms. CONCLUSIONS This study found significant differences between CP patients and normal controls in terms of spinopelvic alignment and hip dysplasia. Furthermore, relationships were found between the sagittal spinopelvic parameters and hip dysplasia, and correlations were found between sagittal spinopelvic parameters and pain.
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Affiliation(s)
- Dong-Hun Suh
- Department of Orthopedics, Korea University Ansan Hospital, Gojan Dong, Danwon Gu, Ansan 425-707, South Korea
| | - Jae-Young Hong
- Department of Orthopedics, Korea University Ansan Hospital, Gojan Dong, Danwon Gu, Ansan 425-707, South Korea.
| | - Seung-Woo Suh
- Scoliosis Research Institute, Department of Orthopedics, Korea University Guro Hospital, 80 Guro-Dong, Guro-Gu, Seoul 152-703, South Korea
| | - Jong-Woong Park
- Department of Orthopedics, Korea University Ansan Hospital, Gojan Dong, Danwon Gu, Ansan 425-707, South Korea
| | - Sang-Hee Lee
- Department of Orthopedics, Korea University Ansan Hospital, Gojan Dong, Danwon Gu, Ansan 425-707, South Korea
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Legg J, Davies E, Raich AL, Dettori JR, Sherry N. Surgical correction of scoliosis in children with spastic quadriplegia: benefits, adverse effects, and patient selection. EVIDENCE-BASED SPINE-CARE JOURNAL 2014; 5:38-51. [PMID: 24715871 PMCID: PMC3969433 DOI: 10.1055/s-0034-1370898] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 12/17/2013] [Indexed: 11/25/2022]
Abstract
STUDY RATIONALE Cerebral palsy (CP) is a group of nonprogressive syndromes of posture and motor impairment associated with lesions of the immature brain. Spastic quadriplegia is the most severe form with a high incidence of scoliosis, back pain, respiratory compromise, pelvic obliquity, and poor sitting balance. Surgical stabilization of the spine is an effective technique for correcting deformity and restoring sitting posture. The decision to operate in this group of patients is challenging. OBJECTIVES The aim of this study is to determine the benefits of surgical correction of scoliosis in children with spastic quadriplegia, the adverse effects of this treatment, and what preoperative factors affect patient outcome after surgical correction. MATERIALS AND METHODS A systematic review was undertaken to identify studies describing benefits and adverse effects of surgery in spastic quadriplegia. Factors affecting patient outcome following surgical correction of scoliosis were assessed. Studies involving adults and nonspastic quadriplegia were excluded. RESULTS A total of 10 case series and 1 prospective and 3 retrospective cohort studies met inclusion criteria. There was significant variation in the overall risk of complications (range, 10.9-70.9%), mortality (range, 2.8-19%), respiratory/pulmonary complications (range, 26.9-57.1%), and infection (range, 2.5-56.8%). Factors associated with a worse outcome were a significant degree of thoracic kyphosis, days in the intensive care unit, and poor nutritional status. CONCLUSION Caregivers report a high degree of satisfaction with scoliosis surgery for children with spastic quadriplegia. There is limited evidence of preoperative factors that can predict patient outcome after scoliosis. There is a need for well-designed prospective studies of scoliosis surgery in spastic quadriplegia.
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Affiliation(s)
- Julian Legg
- Department of Paediatric Respiratory Medicine, University Hospital Southampton, Southampton Children's Hospital, Southampton, United Kingdom
- National Institute of Health Research Biomedical Research Unit in Respiratory Disease, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Evan Davies
- Department of Paediatric Spine Surgery, University Hospital Southampton, Southampton Children's Hospital, Southampton, United Kingdom
| | - Annie L. Raich
- Spectrum Research, Inc., Tacoma, Washington, United States
| | | | - Ned Sherry
- Spectrum Research, Inc., Tacoma, Washington, United States
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Surgical Treatment of Scoliosis in Non-Ambulatory Spastic Quadriplegic Cerebral Palsy Patients: A Matched Cohort Comparison of Unit Rod Technique and All-Pedicle Screw Constructs. Spine Deform 2013; 1:389-394. [PMID: 27927398 DOI: 10.1016/j.jspd.2013.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/11/2013] [Accepted: 07/13/2013] [Indexed: 11/22/2022]
Abstract
STUDY DESIGN Matched cohort. OBJECTIVE To compare the unit rod instrumentation (UR) technique with all-pedicle screw (PS) constructs in the surgical care of scoliosis in Gross Motor Function Classification System IV/V non-ambulatory spastic quadriplegic cerebral palsy patients. SUMMARY OF BACKGROUND DATA Over the past 20 years, there has been a transition from the UR technique to the use of pedicle screws and iliac screws in neuromuscular scoliosis. To date, no head-to-head comparative analysis has been reported between the UR technique and PS constructs for posterior segmental spinal instrumentation and fusion in cerebral palsy patients. METHODS A matched cohort study was performed between 2 tertiary-care pediatric centers: 1 using UR technique and the other PS constructs. Minimum follow-up was 2 years postoperatively (PS 2.5 years, UR 4.6 years, not significant). Fourteen patients were matched from each center based on age (mean age: PS 15.4 years, UR 15.5 years), preoperative pelvic obliquity (mean: PS 33.8°, UR 29.1°) and major coronal Cobb angle (mean: PS 100.9°, UR 100.1°). RESULTS There was posterior-only surgery in 14 of 14 PS and 11 of 14 UR surgeries. The final follow-up Cobb angle was lower in the PS group (13.5° vs. 34.3°, p < .05), with 86.5% correction in the PS group and 65.7% in the UR group. Final follow-up pelvic obliquity was similar (PS 8.5° vs. UR 3.3°; not significant). There were no major complications in the PS group. In the UR group, there was 1 deep infection and 1 reoperation for removal of a prominent sublaminar wire. CONCLUSIONS This is the first study to directly compare UR with PS constructs using matched patient cohorts in this patient population. All-pedicle screw constructs had better correction of coronal Cobb angle, lower blood loss, and shorter hospital stays. There was no difference in the correction of pelvic obliquity, complications, or reoperations.
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Suh SW, Suh DH, Kim JW, Park JH, Hong JY. Analysis of sagittal spinopelvic parameters in cerebral palsy. Spine J 2013; 13:882-8. [PMID: 23541886 DOI: 10.1016/j.spinee.2013.02.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Revised: 11/17/2012] [Accepted: 02/08/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Knowledge of sagittal spinopelvic parameters is important for the treatment of cerebral palsy (CP) because they differ in the normal population and can induce symptoms. PURPOSE To analyze the sagittal spinal alignment and the pelvic orientation in CP. STUDY DESIGN Radiological analysis of patients with CP. METHODS The study and control groups comprised 57 CP patients and 24 healthy volunteers, respectively. All the patients underwent lateral radiography of the whole spine including hip joints. The radiographic parameters examined were sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), S1 overhang (OH), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL1 and 2), and sagittal balance (SB). Statistical analysis was performed to identify the significant differences between the two study groups. In addition, correlations were sought between the parameters and symptoms. RESULTS The PT and OH were significantly smaller in the CP patients, whereas SS, TLK, LL1, LL2, and SB were significantly greater (p<.05). Correlation analysis revealed significant relationships between the sagittal parameters. Specifically, PI was found to be associated with SS, PT, and OH, whereas the spinal parameters LL1 and LL2 were found to be related to TK and SB. Between spine and pelvic parameters, LL1 and LL2 were found to be related to SS, PT, PI, and OH and in addition, SB was found to be related to TLK, LL1, and LL2. An analysis of relations between the symptoms and parameters revealed a positive correlation between the severities of symptoms and PT, OH, and TLK (r=0.300, p=.023; r=0.306, p=.020; r=0.289, p=.029, respectively). CONCLUSIONS A significant difference was observed in the sagittal spinopelvic parameters in the CP and normal control groups and was possibly related to the symptoms. The study shows that the evaluations of sagittal spinopelvic parameters could be useful during the treatment of disorders associated with CP.
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Affiliation(s)
- Seung-Woo Suh
- Department of Orthopedics, Scoliosis Research Institute, Korea University Guro Hospital, 80 Guro-dong, Guro-gu, Seoul 152-703, South Korea
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Bouyer B, Bachy M, Zahi R, Thévenin-Lemoine C, Mary P, Vialle R. Correction of pelvic obliquity in neuromuscular spinal deformities using the "T construct": results and complications in a prospective series of 60 patients. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23:163-71. [PMID: 23860778 DOI: 10.1007/s00586-013-2847-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Revised: 04/21/2013] [Accepted: 06/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND We present the results of a prospective series of 60 patients treated for neuromuscular spinal deformities with an original spinopelvic construct using two sacral screws and two iliac screws. Clinical and radiological results obtained with this new surgical technique were studied and discussed according to the epidemiological data and relevant literature. METHODS From January 2008 to June 2010, the clinical data of every patient who underwent spinopelvic fixation for treatment of a neuromuscular spinal deformity were recorded prospectively. RESULTS Sixty patients were operated on during the study period. Spinal correction and fusion was performed by posterior approach. In six patients with a residual spinopelvic imbalance more than 15° on lateral preoperative bending films, an anterior release of the thoracolumbar junction was performed on the same day, before posterior correction. Preoperative pelvic obliquity (PO) ranged from 4° to 44° (mean 21.6°). Postoperative pelvic obliquity ranged from 0° to 14 (mean 4.6°). No significant loss of correction was noted at the last follow-up. One patient died 3 months after the initial procedure due to respiratory compromise. 11 patients had early postoperative infections of the posterior approach. CONCLUSIONS Despite a high rate of infectious complications, optimal correction of pelvic obliquity requires extension of spinal instrumentation to the pelvis. Spinopelvic fixation remains a difficult challenge in neurological patients with hypotrophy. We think that pelvic fixation with the "T construct" did provide effective and improved spinal stabilization in these patients, while reducing the need for a postoperative cast or brace. As a result, patients had a favourable postoperative course with early mobilization and return to a comfortable sitting position.
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Affiliation(s)
- Benjamin Bouyer
- Department of Pediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie Paris 6, 26 Avenue du Dr. Arnold Netter, 75571, Paris Cedex 12, France
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Abstract
Surgery in a child with spinal deformity is challenging. Although current orthopedic practice ensures good long-term surgical results, complications occur. Idiopathic scoliosis represents the most extensively investigated deformity of the pediatric spine. Nonidiopathic deformities of the spine are at higher risk for perioperative and long-term complications, mainly because of underlying comorbidities. A multidisciplinary treatment strategy is helpful to assure optimization of medical conditions before surgery. Awareness of complications that occur during or after spine surgery is essential to avoid a poor outcome and for future surgical decision making. This article summarizes the complications of surgical treatment of the growing spine.
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Cruz D, Mendoza-Lattes S, Weinstein SL. Nontraumatic Proximal Junctional Kyphosis with Catastrophic Neurologic Deficits After Instrumented Arthrodesis in an Adolescent with Cerebral Palsy: Case Report and Review of the Literature. JBJS Case Connect 2013; 3:e58. [PMID: 29252390 DOI: 10.2106/jbjs.cc.l.00326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Daniel Cruz
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario La Fe Valencia, Avenida Bulevar Sur s/n, Valencia, 46026, Spain.
| | - Sergio Mendoza-Lattes
- Department of Orthopaedics & Rehabilitation, University of Iowa Hospitals and Clinics, 01026 JPP, 200 Hawkins Drive, Iowa City, IA 52242. .
| | - Stuart L Weinstein
- Department of Orthopaedics & Rehabilitation, University of Iowa Hospitals and Clinics, 01026 JPP, 200 Hawkins Drive, Iowa City, IA 52242. .
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Maitra S, Roberto RF, McDonald CM, Gupta MC. Treatment of spine deformity in neuromuscular diseases. Phys Med Rehabil Clin N Am 2012; 23:869-83. [PMID: 23137742 DOI: 10.1016/j.pmr.2012.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Surgical management of spinal deformity in neuromuscular diseases (NMDs) often requires a multidisciplinary approach beginning in the preoperative surgical planning period, owing to concomitant restrictive lung disease and cardiomyopathy in selected NMD conditions. The need for thorough and thoughtful discussions must occur with the family and other caregivers before any scheduled surgery. The decision to proceed with spinal instrumentation may alter functional abilities in weak and marginally ambulatory NMD patients. With care and treatment involving a multidisciplinary team, proper planning, and support, patients will likely experience rewarding outcomes and improved quality of life.
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Affiliation(s)
- Sukanta Maitra
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA 95817, USA
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Dayer R, Ouellet JA, Saran N. Pelvic fixation for neuromuscular scoliosis deformity correction. Curr Rev Musculoskelet Med 2012; 5:91-101. [PMID: 22430864 DOI: 10.1007/s12178-012-9122-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Pelvic fixation is most frequently indicated in the pediatric population for the treatment of neuromuscular scoliosis with significant pelvic obliquity. Neuromuscular scoliosis surgery is associated with a high risk of complications, and this is further increased by extension of fusion to the sacrum. Numerous techniques have been described for pelvic fixation associated with a long spine fusion each with its own set of specific benefits and risks. This article reviews the contemporary surgical techniques of pelvic fixation used to extend a spine fusion to the sacrum and pelvis focusing on the management of neuromuscular scoliosis, including their biomechanical rationale, results, and complications.
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Affiliation(s)
- Romain Dayer
- Division of Pediatric Orthopaedics, Child and Adolescent Department, University Hospitals of Geneva, Rue Willy Donzé 6, 1211, Genève 14, Switzerland,
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Takaso M, Nakazawa T, Imura T, Ueno M, Saito W, Shintani R, Takahashi K, Yamazaki M, Ohtori S, Okamoto M, Masaki T, Okamoto H, Okutomi T, Ishii K, Ueda Y. Can the caudal extent of fusion in the surgical treatment of scoliosis in Duchenne muscular dystrophy be stopped at lumbar 5? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19:787-96. [PMID: 20213296 DOI: 10.1007/s00586-010-1347-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 01/02/2010] [Accepted: 02/11/2010] [Indexed: 10/19/2022]
Abstract
Instrumentation and fusion to the sacrum/pelvis has been a mainstay in the surgical treatment of scoliosis in Duchenne muscular dystrophy (DMD) and is recommended to correct pelvic obliquity. The caudal extent of instrumentation and fusion in the surgical treatment of scoliosis in DMD has remained a matter of considerable debate, and there have been few studies on the use of segmental pedicle screw instrumentation for this pathology. From 2004 to 2007, a total of 28 patients with DMD underwent segmental pedicle screw instrumentation and fusion only to L5. Assessment was performed clinically and with radiologic measurements. All patients had a curve with the apex at L2 or higher preoperatively. Preoperative coronal curve averaged 74 degrees, with a postoperative mean of 14 degrees, and 17 degrees at the last follow-up. The pelvic obliquity improved from 17 degrees preoperatively to 6 degrees postoperatively, and 6 degrees at the last follow-up. Good sagittal plane alignment was recreated after surgery and maintained long term. In 23 patients with a preoperative L5 tilt of less than 15 degrees, the pelvic obliquity was effectively corrected to less than 10 degrees and maintained by adequately addressing spinal deformity, while five patients with a preoperative L5 tilt of more than 15 degrees had a postoperative pelvic obliquity of more than 15 degrees. Segmental pedicle screw instrumentation and fusion to L5 was effective and safe in patients with DMD scoliosis with a minimal L5 tilt (<15 degrees) and a curve with the apex at L2 or higher, both initially and long term, obviating the need for fixation to the sacrum/pelvis. Segmental pedicle screw instrumentation and fusion to L5 was safe and effective in patients with DMD scoliosis with stable L5/S1 articulation as evidenced by a minimal L5 tilt of less than 15 degrees, even though pelvic obliquity was significant. There was no major complication. With rigid segmental pedicle screw instrumentation, the caudal extent of fusion in the treatment of DMD scoliosis should be determined by the degree of L5 tilt. This method in appropriate patients can be a viable alternative to instrumentation and fusion to the sacrum/pelvis in the surgical treatment of DMD scoliosis.
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Affiliation(s)
- Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University, School of Medicine, Kitasato1-15-1, Sagamihara, Kanagawa, 228-8555, Japan.
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21
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Intrasacral rod fixation for pediatric long spinal fusion: results of a prospective study with a minimum 5-year follow-up. J Pediatr Orthop 2009; 29:594-601. [PMID: 19700989 DOI: 10.1097/bpo.0b013e3181b2b403] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lumbosacral fusion is often needed in cases of pediatric neuromuscular spinal deformities. Despite the numerous fixation techniques described, the procedure remains challenging. Jackson has described a method of intrasacral fixation providing immediate 3-dimensional stability and promising clinical results. The purpose of this study was to report our experience with long spinal fusion using Jackson intrasacral fixation in pediatric patients. METHODS All patients with at least 5 years of follow-up were reviewed. No brace was used postoperatively. Clinical data and radiographs were collected and analyzed preoperatively, postoperatively, and at latest follow-up. Intraoperative and postoperative complications were reported. Paired t test was used for statistical analysis. RESULTS Fifty-six patients were included. The average age at surgery was 15.3 years. Mean follow-up period was 10.3 years and no patient was lost to follow-up. All radiographic parameters (frontal balance, frontal Cobb angle of the primary curve, iliolumbar angle, pelvic obliquity, sagittal balance, lumbosacral lordosis, and sacral slope) were significantly improved postoperatively (P<0.001), without significant loss of correction at latest follow-up. Four early infections, 1 pressure sore, and 4 cases of radicular pain, which resolved without intervention, were reported postoperatively. At latest follow-up, no patient complained of lumbar pain, and neither ambulatory status nor activity level ability worsened in any case. Sixteen of the 20 patients who needed a sitting orthosis preoperatively achieved a functional sitting posture without bracing. CONCLUSIONS Jackson fixation is a safe and reliable technique providing immediate stability. In our series, no mechanical complication occurred and no loss of correction was observed, despite immediate unprotected mobilization. The method provides reliable good sacral fixation for pediatric neuromuscular spinal deformities, especially when the correction of severe pelvic obliquity is necessary. LEVEL OF EVIDENCE This consecutive series provides level IV evidence.
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Singh K, Samartzis D, Somera AL, An HS. Cervical kyphosis and thoracic lordoscoliosis in a patient with cerebral palsy. Orthopedics 2008; 31:276. [PMID: 19292233 DOI: 10.3928/01477447-20080301-36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The management of cerebral palsy and spinal deformity can be challenging for spine surgeons. Scoliosis is the most common spinal deformity associated with cerebral palsy; however, the development of thoracic lordoscoliosis is rare. Cervical kyphosis in cerebral palsy patients is associated primarily with athetoid cerebral palsy. This article presents a case of progressive myelopathy and concurrent cervical kyphosis and thoracic lordoscoliosis in a 17-year-old spastic quadriplegic cerebral palsy patient who underwent 2-stage treatment. In the first stage, the cervical spine was managed with a 2-level cervical corpectomy of C5 and C6, with multilevel laminectomies, lateral mass plating, and wire fixation. In the second stage 3 months later, the thoracic deformity was corrected through a combined anterior spinal release of the thoracic spine with posterior spinal segmental instrumentation and sublaminar wiring. Postoperatively, the patient successfully returned to independent ambulation.
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Affiliation(s)
- Kern Singh
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois 60612, USA
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23
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Hahn F, Hauser D, Espinosa N, Blumenthal S, Min K. Scoliosis correction with pedicle screws in Duchenne muscular dystrophy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2007; 17:255-61. [PMID: 18057966 DOI: 10.1007/s00586-007-0558-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Revised: 10/21/2007] [Accepted: 11/15/2007] [Indexed: 11/29/2022]
Abstract
This report describes the spinal fixation with pedicle-screw-alone constructs for the posterior correction of scoliosis in patients suffering from Duchenne muscular dystrophy (DMD). Twenty consecutive patients were prospectively followed up for an average of 5.2 years (min 2 years). All patients were instrumented from T3/T4 to the pelvis. Pelvic fixation was done with iliac screws similar to Galveston technique. The combination of L5 pedicle screws and iliac screws provided a stable caudal foundation. An average of 16 pedicle screws was used per patient. The mean total blood loss was 3.7 l, stay at the intensive care unit was 77 h and hospital stay was 19 days. Rigid stabilisation allowed immediate mobilisation of the patient in the wheel chair. Cobb angle improved 77% from 44 degrees to 10 degrees, pelvic tilt improved 65% from 14 degrees to 3 degrees. Lumbar lordosis improved significantly from 20 degrees to 49 degrees, thoracic kyphosis remained unchanged. No problems related to iliac fixation, no pseudarthrosis or implant failures were observed. The average percentage of predicted forced vital capacity (%FVC) of the patients was 55% (22-94%) preoperatively and decreased to 44% at the last follow-up. There were no pulmonary complications. One patient with a known cardiomyopathy died intraoperatively due to a sudden cardiac arrest. The rigid primary stability with pedicle screws allowed early mobilisation of the patients, which helped to avoid pulmonary complications.
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Affiliation(s)
- Frederik Hahn
- Department of Orthopaedics, Balgrist Clinic, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
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24
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New strategies and decision making in the management of neuromuscular scoliosis. Orthop Clin North Am 2007; 38:485-96, v. [PMID: 17945128 DOI: 10.1016/j.ocl.2007.07.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The outcome of spinal fusion in neuromuscular scoliosis demonstrates a consistently high satisfaction rate among parents and caretakers. It is somewhat more difficult to determine the functional benefits in individual patients, especially in those with the most severe involvement. Even in those children, a predicted 70% survival rate at 11 years has been documented following surgery. Scoliosis is common in children with neuromuscular diseases, especially cerebral palsy. Most of these children need stabilization to enhance their quality of life by improving sitting ability. Studies continue to show a high family satisfaction and caregiver satisfaction following spine reconstructive surgery for neuromuscular scoliosis and other spine deformities.
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25
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Fogel GR, Toohey JS, Neidre A, Brantigan JW. Outcomes of L1-L2 posterior lumbar interbody fusion with the Lumbar I/F cage and the variable screw placement system: reporting unexpected poor fusion results at L1-L2. Spine J 2006; 6:421-7. [PMID: 16825050 DOI: 10.1016/j.spinee.2005.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Revised: 08/17/2005] [Accepted: 09/30/2005] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Posterior lumbar interbody fusion (PLIF) was introduced 50 years ago. The Lumbar I/F cage (DePuy Spine, Raynham, MA) was designed to enhance PLIF results. PLIF with the Lumbar I/F cage and posterior Variable Screw Placement System (VSP) has increased the success of fusion to nearly 100% at the four lowest lumbar levels, L2-L3 through L5-S1. Less commonly, PLIF is indicated for the L1-L2 level. Clinical-results of Lumbar I/F cage fusion and VSP at L1-L2 have-not been reported. PURPOSE The purpose of this study is to report the functional outcomes, fusion rate, and complications related to PLIF with Lumbar I/F cage and VSP of L1-L2 STUDY DESIGN/SETTING The setting is a retrospective, single-arm cohort study of consecutive PLIF surgical patients at a single center. PATIENT SAMPLE A review of 373 of 425 patients who underwent PLIF with Lumbar I/F cage and VSP from 1999 to 2002 identified 12 patients who had PLIF with Lumbar I/F cage and VSP at L1-L2. Mean follow-up was 31 months (range 12-65 months). OUTCOME MEASURES Clinical success was determined with a modified Prolo score evaluating pain, function, medication usage and economic status. Fusion success, determined by evaluation of plain radiographs, was defined by continuous bone bridging the fusion area with no lucencies. METHODS The 12 patients were evaluated for clinical success and/fusion success at last follow-up. These results were compared with the results of the 373 patients reviewed, and historical groups of the original Investigational Device Exemption study and the 10-year follow-up study. RESULTS Previous surgery was reported by 10 of 12 patients, with an average symptom-free period of 3 years after previous fusion and before presentation with severe symptomatology necessitating further surgery at L1-L2. Seven patients had clinical success (59%), and five patients were clinically unsuccessful (41%). This included zero excellent, 2 of 12 (15%) good, 5 of 12 (42%) fair, and 5 of 12 (42%) poor results. Fusion was successful in seven (58%) and failed in five patients (42%). Three failed fusions were associated with L1-L2 subsidence. Two patients required further revision for non-union. CONCLUSIONS In 12 patients with L1-L2 fusion, we report an unexpected high rate of failed fusion and poor clinical outcome.
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Affiliation(s)
- Guy R Fogel
- South Texas Orthopaedic and Spinal Surgery Associates, 9150 Huebner Road, San Antonio, 78240, USA.
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Teli M, Elsebaie H, Biant L, Noordeen H. Neuromuscular scoliosis treated by segmental third-generation instrumented spinal fusion. ACTA ACUST UNITED AC 2006; 18:430-8. [PMID: 16189456 DOI: 10.1097/01.bsd.0000171873.99803.9f] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We aimed to investigate whether the outcome and complications of surgical treatment of neuromuscular curves with segmental third-generation instrumentation could compare with those reported with standard second-generation instrumentation. The clinical and radiologic data of a single surgeon's consecutive series of patients with neuromuscular scoliosis treated with two types of newer-generation instrumentation and posterior or anteroposterior approaches were retrospectively and independently reviewed. The results of this study support the concept that third-generation instrumentation is able to provide at least as good results as second-generation instrumentation in the treatment of neuromuscular scoliosis patients, at the expense of a lower complication rate.
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Affiliation(s)
- Marco Teli
- Great Ormond Street Hospital for Sick Children, London and Royal National Orthopaedic Hospital, Stanmore, UK.
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Klingbeil H, Baer HR, Wilson PE. Aging with a disability 11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil 2004; 85:S68-73; quiz S74-5. [PMID: 15221734 DOI: 10.1016/j.apmr.2004.03.014] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
UNLABELLED This focused review highlights important issues in the care of persons who are aging with a disability. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on significant medical and rehabilitation issues pertinent to persons with cerebral palsy, spina bifida, postpoliomyelitis syndrome, and selected other neurologic and neuromuscular diseases. In addition to normal physiologic aging, people with these conditions often experience secondary complications and accelerated impairments because of aging itself. These complications are described, and monitoring strategies and treatment are recommended. OVERALL ARTICLE OBJECTIVE To summarize issues in the care of persons aging with a disability.
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Affiliation(s)
- Heidi Klingbeil
- Department of Rehabilitation Medicine, University of Colorado Health Sciences Center, Aurora, CO 80045, USA.
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