Skip to main content

Advertisement

SpringerLink
Log in

Long-term outcomes of ilio-sacral screws in minimally invasive bipolar fusionless technique for neuromuscular scoliosis: a retrospective study in 167 patients

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

A Correction to this article was published on 09 February 2022

This article has been updated

Abstract

Introduction

Pelvic fixation in patients with neuromuscular scoliosis is difficult, due to their fragile general condition and poor bone quality. Many techniques have been described, associated with high rates of mechanical complications. The objective of this work was to evaluate the mechanical complications and long-term radiological results of ilio-sacral screw pelvic fixation.

Materials and methods

167 consecutive patients with neuromuscular scoliosis who underwent minimally invasive bipolar fixation with ilio-sacral screw pelvic fixation were retrospectively reviewed. The instrumentation consisted in a bilateral sliding rods construct extended from T1 to the sacrum, anchored proximally by double-hook claws and distally by ilio-sacral screws through a minimally invasive approach. Mechanical complications and radiographic measurements (angle of the major coronal curve, pelvic obliquity, lumbar lordosis) were evaluated preoperatively, postoperatively, and at the last follow-up.

Results

Mean operative age was 12 ± 3 years, and follow-up 6.4 years (3.0–10.4 years). Pelvic obliquity decreased from 20° preoperatively to 5° (77% correction) at last follow-up, Angle of the major coronal curve from 75° to 36° (52% correction), and lumbar lordosis from 28° to 38°. 16 mechanical complications in nine patients occurred: screw prominence (n = 1), connector failure (n = 4), screw malposition (n = 11). Unplanned surgery was required in seven cases, two were managed during rod lengthening, seven did not require treatment.

Conclusion

In this series of neuromuscular patients operated by ilio-sacral screws as pelvic fixation, the results were stable with a mean follow-up of more than 6 years and the complication rate was reduced comparatively to the literature.

Level of evidence

4

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
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Change history

References

  1. Thometz JG, Simon SR et al (1988) Progression of scoliosis after skeletal maturity in institutionalized adults who have cerebral palsy. J Bone Joint Surg Am 70:1290–1296

    Article  CAS  PubMed  Google Scholar 

  2. Rumalla K, Yarbrough CK, Pugey AJ (2016) Spinal fusion for pediatric neuromuscular scoliosis: national trends, complications and in hospital outcomes. J Neurosurg Spine 25:500–508

    Article  PubMed  Google Scholar 

  3. Miller A, Temple T, Miller F (1996) Impact of orthoses on the rate of scoliosis progression in children with cerebral palsy. J Pediatr Orthop 16:332–335

    Article  CAS  PubMed  Google Scholar 

  4. McElroy MJ, Sponseller PD, Dattilo JR et al (2012) Growing rods for the treatment of scoliosis in children with cerebral palsy: a critical assessment. Spine 37:E1504–E1510

    Article  PubMed  Google Scholar 

  5. Sponseller PD, Yang JS, Thompson GH, McCarthy RE et al (2009) Pelvic fixation of growing rods: comparison of constructs. Spine 34:1706–1710

    Article  PubMed  Google Scholar 

  6. Anari J, Spiegel D, Baldwin K (2015) Neuromuscular scoliosis and pelvic fixation in 2015: where do we stand? World J Orthop 6(8):564–566

    Article  PubMed  PubMed Central  Google Scholar 

  7. Dayer R, Ouellet JA, Saran N (2012) Pelvic fixation for neuromuscular scoliosis deformity correction. Curr Rev Musculoskelet Med 5(2):91–101

    Article  PubMed  PubMed Central  Google Scholar 

  8. Peele MW, Lenke LG, Bridwell KH et al (2006) Comparison of pelvic fixation techniques in neuromuscular spinal deformity correction: galveston rod versus iliac and lumbosacral screws. Spine 31(20):2392–2398 (discussion 2399)

    Article  Google Scholar 

  9. Miladi L, Gaume M, Khouri N, Johnson M et al (2018) Minimally invasive surgery for neuromuscular scoliosis: results and complications in a series of one hundred patients. Spine 43:E968–E975

    Article  PubMed  PubMed Central  Google Scholar 

  10. Miladi LT, Ghanem IB, Draoui MM et al (1997) Ilio-sacral screw fixation for pelvic obliquity in neuromuscular scoliosis. A long-term follow-up study. Spine 22:1722–1729

    Article  CAS  PubMed  Google Scholar 

  11. Dubousset J, Gaume M, Miladi L (2021) Ilio-sacral screw pelvic fixation when correcting spinal deformities with or without pelvic obliquity: our experience over 40 years. Spine Deform 9(3):665–670. https://doi.org/10.1007/s43390-020-00263-6

    Article  PubMed  Google Scholar 

  12. Zahi R, Vialle R, Abelin K et al (2010) Spinopelvic fixation with ilio-sacral screws in neuromuscular spinal deformities: results in a prospective cohort of 62 patients. Childs Nerv Syst 26(1):81–86

    Article  PubMed  Google Scholar 

  13. Harrington P, Tullos H (1971) Spondylolisthesis in children: observations and surgical treatment. Clin Orthop Relat Res 79:75–84

    Article  CAS  PubMed  Google Scholar 

  14. Akbarnia BA, Breakwell LM, Marks DS et al (2008) Dual growing rod technique followed for three to eleven years until final fusion: the effect of frequency of lengthening. Spine 33:984–990

    Article  PubMed  Google Scholar 

  15. Thompson GH, Akbarnia BA, Campbell RM et al (2007) Growing rod techniques in early-onset scoliosis. J Pediatr Ortho 27:354–361

    Article  Google Scholar 

  16. Gaume M, Persohn S, Vergari C, Glorion C et al (2020) Biomechanical cadaver study of proximal fixation in a minimally invasive bipolar construct. Spine Deform 8(1):33–38

    Article  CAS  PubMed  Google Scholar 

  17. Sun X, Li S, Qiu Y et al (2018) Anatomical study of a novel ilio sacral screw placement for sacrum-pelvis in adult via computed tomography reconstruction. Spine 43(13):E740–E745

    Article  PubMed  Google Scholar 

  18. Brooks JT, Jain A, Sanchez-Perez-Grueso F, Skaggs DL et al (2016) Outcomes of pelvic fixation in growing rod constructs: an analysis of patients with a minimum of 4 years of follow-up. Spine Deform 4:211–216

    Article  PubMed  Google Scholar 

  19. Ramirez N, Flynn JM, Smith JT et al (2015) Use of the S-hook for pelvic fixation in rib-based treatment of early-onset scoliosis: a multicenter study. Spine 40:816–822

    Article  PubMed  Google Scholar 

  20. Walick KS, King JT, Johnston CE et al (2008) Neuropathic lower extremity pain following Dunn-McCarthy instrumentation. Spine 33:E877–E880

    Article  PubMed  Google Scholar 

  21. Ould-Slimane M, Miladi L, Rousseau MA, Bonaccorsi R (2013) Catonnes-Y, Lazennec JY, Moussellard HP (2013). Sacropelvic fixation with iliosacral screws: applications and results in adult spinal deformities. J Spinal Disord Tech. 26(4):212–217

    Article  PubMed  Google Scholar 

  22. Reames DL, Smith JS, Fu KM, Polly DW Jr, Ames CP, Berven SH, Perra JH, Glassman SD, Mc Carthy RE, Knapp RD Jr, Heary R, Shaffrey CI (2011) Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the scoliosis research society morbidity and mortality database. Spine (Phila Pa 1976) 36(18):1484–1491

    Article  PubMed  Google Scholar 

  23. Sharma S, Wu C, Andersen T, Wang Y, Hansen ES, Bünger CE (2013) Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years. Eur Spine J 22(6):1230–1249

    Article  PubMed  Google Scholar 

  24. Cognetti D, Keeny HM, Samdani AF, Pahys JM, Hanson DS, Blanke K, Hwang SW (2017) Neuromuscular scoliosis complication rates from 2004 to 2015: a report from the scoliosis research society morbidity and mortality database. Neurosurg Focus 43(4):E10

    Article  PubMed  Google Scholar 

  25. Miladi L, Khouri N, Pradon J, Elie C, Treluyer JM (2021) One way self-expanding rod for early onset scoliosis: early results of a clinical trial of 20 patients. Eur Spine J 30(3):749–758

    Article  PubMed  Google Scholar 

  26. Palmisani M, Dema E, Palmisani R, Cervellati S (2020) Surgical treatment of neuromuscular spine deformity with minimally invasive fusionless surgery: an innovative technique. Giornale Italiano di Ortopedia e Traumatologia 46:1–8

    Google Scholar 

  27. Gaume M, Vergari C, Khouri N, Skalli W, Glorion C, Miladi L (2021) Minimally invasive surgery for neuromuscular scoliosis: results and complications at a minimal follow-up of 5 years. Spine (Phila Pa 1976). https://doi.org/10.1097/BRS.0000000000004082

    Article  PubMed  Google Scholar 

  28. Wolff S, Habboubi K, Sebaaly A et al (2019) Correction of adult spinal deformity with a minimally invasive fusionless bipolar construct: preliminary results. Orthop Traumatol Surg Res 105:1149–1155

    Article  PubMed  Google Scholar 

  29. Toll BJ, Samdani AF, Janjua MB, Gandhi S, Pahys JM et al (2018) Perioperative complications and risk factors in neuromuscular scoliosis surgery. J Neurosurg Pediatr 22(2):207–213

    Article  PubMed  Google Scholar 

Download references

Funding

Euros® is the manufacturer of the ilio-sacral screws. It had no role in the design of the study, collection of the data, analysis or interpretation of the results, writing of the article, or decision to submit it. No author of this article received any financial or nonfinancial contribution related to this study.

Author information

Authors and Affiliations

  1. Pediatric Orthopedic Surgery Department, Paris Descartes University, Assistance Publique Hôpitaux de Paris (AP-HP),Necker Hospital, 149 rue de Sevres, 75015, Paris, France

    Mathilde Gaume, Pierre Gerard, Nejib Khouri, Christophe Glorion & Lotfi Miladi

  2. French National Academy of Medicine, Paris, France

    Jean Dubousset

Authors
  1. Mathilde Gaume
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pierre Gerard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nejib Khouri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christophe Glorion
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jean Dubousset
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lotfi Miladi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MG: study design, statistics, data interpretation, manuscript drafting, and approval of the final version to be published. PG: study design, statistics, manuscript drafting and revision for important intellectual content, and approval of the version to be published. NK: approval of the final version to be published. PG: approval of the final version to be published. JDD: revision for important intellectual content and approval of the final version to be published. LM: study design, manuscript drafting, revision for important intellectual content and approval of the final version to be published.

Corresponding author

Correspondence to Lotfi Miladi.

Ethics declarations

Conflict of interest

L. Miladi has intellectual property rights with Euros company.

Ethical approval

CPP, ID-EUDRACT # 2014 A019043 44.

Informed consent

Informed consent was obtained from all participants.

Additional information

Publisher's Note

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gaume, M., Gerard, P., Khouri, N. et al. Long-term outcomes of ilio-sacral screws in minimally invasive bipolar fusionless technique for neuromuscular scoliosis: a retrospective study in 167 patients. Arch Orthop Trauma Surg 143, 1761–1767 (2023). https://doi.org/10.1007/s00402-021-04332-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-021-04332-x

Keywords

Search

Navigation