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Screw augmentation for spinopelvic fixation in neuromuscular spine deformities: technical note

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Abstract

Purpose

The primary goal of curve correction in neuromuscular patients is to restore coronal and sagittal trunk balance, including the pelvis, to maximize sitting balance. For several years, it has been a common practice to inject polymeric cement into osteoporotic bone through specially designed, perforated pedicle screws in an effort to enhance screw stability. Therefore, we started using the association of a spinopelvic fixation with S1 pedicle screw augmentation, using bisphenol-a-glycidyl dimethacrylate composite resin in neuromuscular patients with pelvic obliquity, technique in neuromuscular patients to improve pedicle screw stability of our pelvic construct.

Methods

Ten patients undergoing spinopelvic fixation for a neuromuscular spinal deformity were enrolled in the study. Clinical and radiographic data were analyzed and presented. Minimal follow-up took place at 6 months to assess early complications.

Results

Five patients were diagnosed with spastic quadriplegia secondary to cerebral palsy, four had Duchenne’s muscular dystrophy, and one had a T5-level traumatic flaccid paraplegia. Preoperative PO ranged from 8° to 34° (mean 19.16°). Postoperative PO ranged from 0° to 6.3° (mean 1.6°). After surgery, all patients returned to a full-time sitting position between days 5 and 12 without the need for additional bracing. No mechanical failure of the construct was noted during follow-up.

Conclusions

We used sacral pedicle screw augmentation as a reliable tool to strengthen spinopelvic fixation in neuromuscular scoliosis without increasing the intraoperative morbidity. In our practice, sacral screw augmentation can definitely enhance PO correction obtained by a posterior procedure.

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Acknowledgments

The authors would like to thank Gerald Pennington and Mistina Picciano for their valuable comments and suggestions in improving the quality of the paper.

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Correspondence to Raphaël Vialle.

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As precised in the disclosure form, Prof R VIALLE works as a consultant for Stryker Spine SAS (consultant honorarium less than 25 000$/year). Other co-authors do not have conflicts of interest.

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Dubory, A., Bachy, M., Bouloussa, H. et al. Screw augmentation for spinopelvic fixation in neuromuscular spine deformities: technical note. Eur Spine J 24, 2580–2587 (2015). https://doi.org/10.1007/s00586-015-4155-z

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  • DOI: https://doi.org/10.1007/s00586-015-4155-z

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