Scoliosis Research Today is a free monthly online journal that collates and summarizes the latest research about Scoliosis, including details on treatment, exercises, surgery, symtpoms. | ||||||||
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Treatment of neuromuscular scoliosis with posterior-only pedicle screw fixation.Modi HN, Suh SW, Song HR, Fernandez HM, Yang JH Scoliosis Research Institute, Department of Orthopedics, Korea University Guro Hospital, Seoul, Korea. spine@korea.ac.kr. ABSTRACT: BACKGROUND: 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. METHODS: Between 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). RESULTS: Average Cobb's angle was 78.53 degrees before surgery, 30.70 degrees after surgery (60.9% correction), and 33.06 degrees at final follow-up (57.9% correction) showing significant correction (p < 0.0001). There were 9 patients with curves more than 90 degrees showed an average pre-operative, post operative and final follow up Cobb's angle 105.67 degrees , 52.33 degrees (50.47% correction) and 53.33 degrees (49.53% correction) respectively and 17 patients with curve less than 90 degrees 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 degrees before surgery, 8.96 degrees after surgery, and 9.27 degrees 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. CONCLUSION: Results 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. Published 23 June 2008 in J Orthop Surg, 3: 23.
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