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Pre-op considerations in neuromuscular scoliosis deformity surgery: proceedings of the half day course at the 58th annual meeting of the Scoliosis Research Society

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Abstract

Scoliosis is a common complication of neuromuscular disorders. These patients are frequently recalcitrant to nonoperative treatment. When treated surgically, they have the highest risk of complications of all forms of scoliosis. While recent studies have shown an improvement in the rate of complications, they still remain high ranging from 6.3 to 75% depending upon the underlying etiology and the treatment center (Mohamad et al. in J Pediatr Orthop 27:392–397, 2007; McElroy et al. in Spine, 2012; Toll et al. in J Neurosurg Pediatr 22:207–213, 2018; Cognetti et al. in Neurosurg Focus 43:E10, 2017). For those patients who are able to recover from the perioperative period without major complications, several recent studies have shown decreased long-term mortality and improved health-related quality of life in neuromuscular patients who have undergone spine fusion (Bohtz et al. in J Pediatr Orthop 31:668–673, 2011; Ahonen et al. in Neurology 101:e1787–e1792, 2023; Jain et al. in JBJS 98:1821–1828, 2016). It is critically important to optimize patients preoperatively to minimize the risk of post-operative complications and maximize long-term outcomes. In order to do so, one must familiarize themselves with the common complications and their treatment. The most common complications are pulmonary in nature. With reported rates as high as 23–29%, pre-operative optimization should be employed for these patients to minimize the risk of post-operative complications (Sharma et al. in Eur Spine J 22:1230–1249, 2013; Rumalla et al. in J Neurosurg Spine 25:500–508, 2016). The next most common cause of complications are implant related, with 13–23% of patients experiencing an implant-related complication that may require a second procedure (Toll et al. in J Neurosurg Pediatr 22:207–213, 2018; Sharma et al. in Eur Spine J 22:1230–1249, 2013) Therefore optimization of bone quality prior to surgical intervention is important to help minimize the risk of instrumentation failure. Optimization of muscle tone and spasticity may help to decrease the risk of instrumentation complications, but may also contribute to the progression of scoliosis. While only 3% of patients have neurologic complication, significant equipoise remains regarding whether or not patients should undergo prophylactic detethering procedures to minimize those risks (Sharma et al. in Eur Spine J 22:1230–1249, 2013). Although only 1.8% of complications are classified as cardiac related, they can be among the most devastating (Rumalla et al. in J Neurosurg Spine 25:500–508, 2016). Simply understanding the underlying etiology and the potential risks associated with each condition (i.e., conduction abnormalities in a patient with Rett syndrome or cardiomyopathies patients with muscular dystrophy) can be lifesaving. The following article is a summation of the half day course on neuromuscular scoliosis from the 58th annual SRS annual meeting, summarizing the recommendations from some of the world’s experts on medical considerations in surgical treatment of neuromuscular scoliosis.

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Authors and Affiliations

  1. Shriners Children’s Portland, 3101 SW Sam Jackson Park Road, Portland, OR, 97229, USA

    Michelle C. Welborn & Lindsey Nicol

  2. Pulmonary and Sleep Medicine Division, Seattle Children’s Hospital, Room O.C. 7.730, 4800 Sand Point Way N E, Seattle, WA, 98105, USA

    Gregory Redding

  3. Doernbecher Children’s Hospital, 700 SW Campus Dr, Portland, OR, 97239, USA

    Patrick Evers & Lindsey Nicol

  4. Texas Children’s Hospital, 6701 Fannin St., Suite 1230.01, Houston, TX, USA

    David F. Bauer

  5. 100 N. Mario Capecchi Drive, Suite 3850, Salt Lake City, UT, 84113, USA

    Rajiv R. Iyer

  6. Shriners Children’s Southern California, 909 S. Fair Oaks Ave, Pasadena, CA, 91105, USA

    Selina Poon

  7. Shriners Children’s Philadelphia, 3551 N Broad St., Philadelphia, PA, 19140, USA

    Steven Hwang

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  1. Michelle C. Welborn
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Contributions

Michelle Cameron Welborn: conception/design, data acquisition, interpretation, drafted/revised work, approved final version. Gregory Redding, Patrick Evers, Lindsey Nicol, David Bauer, and Rajiv Iyer: data acquisition, interpretation, drafted/revised work, approved final version. Selina Poon and Steven Hwang: data acquisition, drafted/revised work, approved final version. All the authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Michelle C. Welborn.

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Conflict of interest

Dr. Welborn reports grants from POSNA, grants from Shriners Hospital for Children, during the conduct of the study; personal fees and other from Depuy Synthes, personal fees from Nuvasive, personal fees from Stryker/K2M, personal fees from Orthopediatrics, Personal fees from AstraZenica outside the submitted work. Dr. Evers has nothing to disclose. Dr. Nicol reports personal fees from Egetis, personal fees from Ultragenyx, outside the submitted work. Dr. Bauer has nothing to disclose. Dr. Iyer has nothing to disclose. Dr. Poon reports grants from Pediatric Orthopedic Society of North America, personal fees from Medtronic Spine, personal fees from Orthopediatrics, grants from OREF, outside the submitted work. Dr. Hwang reports personal fees from NASS, other from Auctus, outside the submitted work.

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Welborn, M.C., Redding, G., Evers, P. et al. Pre-op considerations in neuromuscular scoliosis deformity surgery: proceedings of the half day course at the 58th annual meeting of the Scoliosis Research Society. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00865-4

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