Treatment of neuromuscular scoliosis with posterior-only pedicle screw fixation

Hitesh N. Modi, Seung-Woo Suh, Hae Ryong Song, Harry M. Fernandez, Jae Hyuk Yang

Research output: Contribution to journalArticle

29 Citations (Scopus)

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° 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. 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.

Original languageEnglish
Article number23
JournalJournal of Orthopaedic Surgery and Research
Volume3
Issue number1
DOIs
Publication statusPublished - 2008 Jun 30

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Scoliosis
Therapeutics
Duchenne Muscular Dystrophy
Joint Diseases
Poliomyelitis
Wound Infection
Cerebral Palsy
Pedicle Screws
Lower Extremity
Spine
Mortality
Population

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Treatment of neuromuscular scoliosis with posterior-only pedicle screw fixation. / Modi, Hitesh N.; Suh, Seung-Woo; Song, Hae Ryong; Fernandez, Harry M.; Yang, Jae Hyuk.

In: Journal of Orthopaedic Surgery and Research, Vol. 3, No. 1, 23, 30.06.2008.

Research output: Contribution to journalArticle

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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° 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. 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.",
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N2 - 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° 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. 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.

AB - 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° 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. 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.

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