Skip to main content

Advertisement

SpringerLink
Log in

Hip reduction surgery versus scoliosis correction in non-ambulant neuromuscular patients: which surgery is the first step?

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Purpose

Children and young adults with neuromuscular disorders have a high incidence of both spine and hip deformities. The aim of this study was to evaluate the outcome of either primary scoliosis or hip surgery in children and young adults with neuromuscular disorders.

Methods

A retrospective study was conducted on all children and young adults with neuromuscular-related synchronous hip subluxation/dislocation and scoliosis undergoing hip or scoliosis surgery in our institution between 2012 and 2021 with a minimum follow-up of 24 months. Demographic and operative data were collected; radiological parameters were measured preoperatively and postoperatively at final follow-up.

Results

Forty neuromuscular patients with synchronous hip displacement and scoliosis were included. Twenty patients with an average age of10.2 years had hip correction surgery performed primarily, with a mean follow-up of 54.9 (24–96) months. The other 20 patients with an average age of 12.4 years had scoliosis correction first, with a mean follow-up of 40 (24–60) months. In the “Hip first” group, pelvic obliquity, hip MP and Cobb angle were 16.8°, 71%, and 49°, respectively. At final follow-up, the mean pelvic obliquity and Cobb angles significantly progressed to 27.2° (p = 0.003) and 82.2° (p = 0.001), respectively. Eighteen patients (90%) required scoliosis correction after the hip surgery. In the “Scoliosis first” group, the mean pelvic obliquity, hip MP and Cobb angle were 21.2°, 49% and 65.5°, respectively. At final follow-up, both pelvic obliquity and Cobb angle significantly improved to 8.44° (p = 0.002) and 23.4° (p = 0.001), respectively. In 11/20 (55%) patients, the hip MP had significantly increased following the spinal surgery to 62% (p = 0.001), but only 5/20 (25%) patients underwent hip surgery after scoliosis correction.

Conclusion

In neuromuscular patients presenting with synchronous hip displacement and scoliosis deformity, corrective scoliosis surgery is associated with a significant correction of pelvic obliquity and lower rates of secondary hip surgery. On the other hand, primary hip surgery does not reduce the risk of pelvic obliquity and scoliosis deformity progression.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Murphy RF, Mooney JF 3rd (2019) Current concepts in neuromuscular scoliosis. Curr Rev Musculoskelet Med 12(2):220–227. https://doi.org/10.1007/s12178-019-09552-8

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hsu PC, Feng CK, Huang SH, Chiu JW, Chou CL, Yang TF (2019) Health-related quality of life in children and adolescent with different types of scoliosis: a cross-sectional study. J Chin Med Assoc 82(2):161–165. https://doi.org/10.1097/JCMA.0000000000000020

    Article  PubMed  Google Scholar 

  3. Graham HK, Rosenbaum P, Paneth N, Dan B, Lin JP, Damiano DL, Becher JG, GaeblerSpira D, Colver A, Reddihough DS et al (2016) Cerebral palsy. Nat Rev Dis Prim 2:15082. https://doi.org/10.1038/nrdp.2015.82

    Article  PubMed  Google Scholar 

  4. Fujak A, Raab W, Schuh A, Richter S, Forst R, Forst J (2013) Natural course of scoliosis in proximal spinal muscular atrophy type II and IIIa: descriptive clinical study with retrospective data collection of 126 patients. BMC Musculoskelet Disord 14:283

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mehta S, Gibson J (2003) The treatment of neuromuscular scoliosis. Curr Orthop 17:313–321. https://doi.org/10.1016/S0268-0890(03)00002-1

    Article  Google Scholar 

  6. Miyanji F, Nasto LA, Sponseller PD, Shah SA, Samdani AF, Lonner B, Yaszay B, Clements DH, Narayanan U, Newton PO (2018) Assessing the risk-benefit ratio of scoliosis surgery in cerebral palsy: surgery is worth it. JBJS 100(7):556–563

    Article  Google Scholar 

  7. Miller DJ, Flynn JJM, Pasha S, Yaszay B, Parent S, Asghar J, Abel MF, Pahys JM, Samdani A, Hwang SW, Narayanan UG (2020) Improving health-related quality of life for patients with nonambulatory cerebral palsy: who stands to gain from scoliosis surgery? J Pediatr Orthop 40(3):e186–e192

    Article  PubMed  Google Scholar 

  8. DiFazio RL, Miller PE, Vessey JA, Snyder BD (2017) Health-related quality of life and care giver burden following spinal fusion in children with cerebral palsy. Spine 42(12):E733–E739

    Article  PubMed  Google Scholar 

  9. Patel J, Shapiro F (2015) Simultaneous progression patterns of scoliosis, pelvic obliquity, and hip subluxation/dislocation in non-ambulatory neuromuscular patients: an approach to deformity documentation. J Child Orthop 9(5):345–356. https://doi.org/10.1007/s11832-015-0683-7. (Epub 2015 Sep 30)

    Article  PubMed  PubMed Central  Google Scholar 

  10. Senaran H, Shah SA, Glutting JJ, Dabney KW, Miller F (2006) The associated effects of untreated unilateral hip dislocation in cerebral palsy scoliosis. J Pediatr Orthop 26(6):769–772. https://doi.org/10.1097/01.bpo.0000242426.60995.29

    Article  PubMed  Google Scholar 

  11. Krebs A, Strobl WM, Grill F (2008) Neurogenic hip dislocation in cerebral palsy: quality of life and results after hip reconstruction. J Child Orthop 2(2):125–131. https://doi.org/10.1007/s11832-008-0080-6. (Epub 2008 Feb 13)

    Article  PubMed  PubMed Central  Google Scholar 

  12. Crawford L, Herrera-Soto J, Ruder JA, Phillips J, Knapp R (2017) The fate of the neuromuscular hip after spinal fusion. J Pediatr Orthop 37(6):403–408. https://doi.org/10.1097/BPO.0000000000000689

    Article  PubMed  Google Scholar 

  13. Helenius IJ, Viehweger E, Castelein RM (2020) Cerebral palsy with dislocated hip and scoliosis: what to deal with first? J Child Orthop 14(1):24–29. https://doi.org/10.1302/1863-2548.14.190099

    Article  PubMed  PubMed Central  Google Scholar 

  14. Cooperman DR, Bartucci E, Dietrick E, Millar EA (1987) Hip dislocation in spastic cerebral palsy: long-term consequences. J Pediatr Orthop 7(3):268–276. https://doi.org/10.1097/01241398-198705000-00005

    Article  CAS  PubMed  Google Scholar 

  15. Asma A, Cobanoglu M, Ulusaloglu AC, Rogers KJ, Miller F, Howard JJ, Shah SA, Shrader MW (2023) Hip displacement does not change after pelvic obliquity correction during spinal fusion in children with cerebral palsy. J Pediatr Orthop 43(2):e127–e131. https://doi.org/10.1097/BPO.0000000000002292. (Epub 2022 Nov 15)

    Article  PubMed  Google Scholar 

  16. Cobanoglu M, Chen BP, Perotti L, Rogers K, Miller F (2020) The impact of spinal fusion on hip displacement in cerebral palsy. Indian J Orthop 55(1):176–182. https://doi.org/10.1007/s43465-020-00271-8

    Article  PubMed  PubMed Central  Google Scholar 

  17. Huser A, Mo M, Hosseinzadeh P (2018) Hip surveillance in children with cerebral palsy. Orthop Clin N Am 49(2):181–190. https://doi.org/10.1016/j.ocl.2017.11.006. (Epub 2018 Feb 3)

    Article  Google Scholar 

  18. Roberts SB, Tsirikos AI (2016) Factors influencing the evaluation and management of neuromuscular scoliosis: a review of the literature. J Back Musculoskelet Rehabil 29:613–623. https://doi.org/10.3233/BMR-160675

    Article  PubMed  Google Scholar 

  19. Yoshida K, Kajiura I, Suzuki T, Kawabata H (2018) Natural history of scoliosis in cerebral palsy and risk factors for progression of scoliosis. J Orthop Sci 23:649–652. https://doi.org/10.1016/j.jos.2018.03.009

    Article  PubMed  Google Scholar 

  20. Repko M, Filipovič M, Leznar M, Šprláková-Puková A, Heger J (2018) S2 alar-iliac šrouby při fixaci a korekci kombinovaných neuromuskulárních deformit páteře a pánve [S2 alar-iliac screws in fixation and correction of combined neuromuscular spinal and pelvic deformities]. Acta Chir Orthop Traumatol Cech 85(3):194–198

    Article  CAS  PubMed  Google Scholar 

  21. Lonstein JE, Beck K (1986) Hip dislocation and subluxation in cerebral palsy. J Pediatr Orthop 6(5):521–526. https://doi.org/10.1097/01241398-198609000-00001

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

We are the authors of “Hip reduction surgery versus scoliosis correction in non-ambulant neuromuscular patients. Which surgery is the first step?”. From the moment this study was conceived until the time it was completed, we have had no financial conflicts of interest in writing this manuscript nor had any assistance from any other parties that could affect or produce a financial bias.

Author information

Authors and Affiliations

  1. The Centre for Spinal Studies and Surgery (CSSS), Queen’s Medical Centre, Nottingham University Hospitals, Derby Rd, Lenton, Nottingham, NG7 2UH, UK

    Mostafa Ali Khaleefa ELMeshneb, Alan Gessara, Elie Najjar, Mohammed Shakil Patel, Masood Shafafy & Nasir A. Quraishi

  2. Orthopaedic and Traumatology Department, Sohag University Hospitals, Nasr City, Sohag, 82532, Egypt

    Ahmed Sleem, Ahmed H. K. Abdelaal & Mohamed E. Abdel-Wanis

Authors
  1. Mostafa Ali Khaleefa ELMeshneb
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alan Gessara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elie Najjar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ahmed Sleem
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ahmed H. K. Abdelaal
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mohamed E. Abdel-Wanis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mohammed Shakil Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masood Shafafy
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Nasir A. Quraishi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MAKEM, MSP, AG and EN. The first draft of the manuscript was written by MS, NAQ and AS, MEA-W, AHKA commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mostafa Ali Khaleefa ELMeshneb.

Ethics declarations

Ethical approval

Ethical approval was waived by the local Ethics Committee of our university in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

ELMeshneb, M.A.K., Gessara, A., Najjar, E. et al. Hip reduction surgery versus scoliosis correction in non-ambulant neuromuscular patients: which surgery is the first step?. Spine Deform 12, 747–754 (2024). https://doi.org/10.1007/s43390-023-00804-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43390-023-00804-9

Keywords

Search

Navigation