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Limitations of posterior spinal fusion to L5 for flaccid neuromuscular scoliosis focusing on pelvic obliquity

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Abstract

Study design

Retrospective comparison based on the degree of pelvic obliquity (PO).

Purpose

To assess the controversial indications for and limitations of ending the instrumentation for posterior spinal fusion (PSF) at L5 in patients with flaccid neuromuscular scoliosis (fNMS).

Methods

We reviewed the cases of 45 patients with progressive spinal deformity as a result of fNMS treated by PSF to L5 and followed for an average of 4 years postoperatively with adequate clinical and radiological data. Anterior–posterior and lateral whole spine radiographs were evaluated. We divided patients into two groups based on the degree of pelvic obliquity (PO) at the final follow-up. Radiographic data from the two groups were analyzed to identify the indications and limitations of this surgical method focusing on PO.

Results

Preoperatively, there were significant differences between the two groups in Cobb angle, PO, thoracolumbar kyphosis, and lumbar lordosis (LL) while sitting; Cobb angle and LL while supine (Supine Cobb, and Supine LL); and major curve flexibility. Multivariate logistic regression analysis identified Supine Cobb and Supine LL as independent risk factors for residual PO at the final follow-up (Supine Cobb: odds ratio, 1.1; 95% confidence interval 1.0–1.2, Supine LL: odds ratio, 0.9; 95% confidence interval 0.8–1.0).

Conclusion

Patients with larger preoperative Cobb angle and smaller LL while supine may not achieve adequate spine and pelvic correction and this may lead to deterioration in the PO over time, even after spinal fusion ending at L5.

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Funding

This work was supported in part by an Intramural Research Grant (29-3) for Neurological and Psychiatric Disorders from the National Center of Neurology and Psychiatry and a Kitasato University Research Grant for Young Researchers.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Wataru Saito, Gen Inoue, Eiki Shirasawa, Takayuki Imura, Toshiyuki Nakazawa, Masayuki Miyagi, Ayumu Kawakubo, Kentaro Uchida & Masashi Takaso

  2. Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan

    Toshiaki Kotani

  3. Department of Orthopedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan

    Tsutomu Akazawa

Authors
  1. Wataru Saito
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  2. Gen Inoue
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  3. Eiki Shirasawa
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  4. Takayuki Imura
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  5. Toshiyuki Nakazawa
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  6. Masayuki Miyagi
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  7. Ayumu Kawakubo
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  8. Kentaro Uchida
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  9. Toshiaki Kotani
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  10. Tsutomu Akazawa
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  11. Masashi Takaso
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Contributions

Design of the work: WS, GI, MT. Acquisition of the data: EI, TI, TN, AK, KU, TA. Interpretation of the data: WS, GI, TK, MT. Drafting the work: all authors. Final approval of the version to be published: all authors. Agreement to be accountable for all aspects of the work: all authors.

Corresponding author

Correspondence to Gen Inoue.

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Conflict of interest

The authors declare that they have no conflict of interest related directly or indirectly to this manuscript. No relevant financial activities outside the submitted work. The manuscript submitted does not contain information about medical device(s)/drug(s).

Ethical approval

The present study was conducted under a protocol approved by the institutional review board of Kitasato University School of Medicine.

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Saito, W., Inoue, G., Shirasawa, E. et al. Limitations of posterior spinal fusion to L5 for flaccid neuromuscular scoliosis focusing on pelvic obliquity. Spine Deform 9, 559–565 (2021). https://doi.org/10.1007/s43390-020-00214-1

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  • DOI: https://doi.org/10.1007/s43390-020-00214-1

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