Abstract
Study design
The present study was a retrospective analysis.
Objective
The purpose of the study was to evaluate the safety and efficacy of the maximum-width (M-W) segmental sacropelvic fixation technique, comprising iliac screws and/or iliosacral pedicle screws, to correct severe pelvic obliquity.
Summary and background data
Classic spinal fixation using the Luque–Galveston procedure for the correction of neuromuscular scoliosis may be inadequate to manage severe pelvic obliquities.
Methods
A series of 20 consecutive patients with severe neuromuscular spinopelvic deformities was reviewed by an independent observer. Coronal and sagittal Cobb angle, frontal pelvic obliquity, and trunk shift were measured preoperatively, immediately postoperatively and at final follow-up.
Results
All 20 patients underwent spinal fusion with instrumentation extending to the pelvis. Fourteen cases had primary operations, and six patients had undergone previous spinal fusion above the pelvis, requiring extension to the pelvis. The mean age of the patients at surgery was 13 years, and the mean duration of the follow-up period was 36 months. The mean preoperative Cobb angle was 84° (range 56°–135°), which was corrected to a mean of 41° (range 8°–75°) postoperatively. At the final follow-up, the mean spinal curve remained at 42° (range 10°–75°). The mean preoperative pelvic obliquity was 42° (range 15°–105°), which was corrected by 78 % to 9° (range 0°–49°) postoperatively, with a pelvic obliquity of 10° (range 2°–49°) at final follow-up. Comparing the results of the present study with results in the literature describing the Luque–Galveston or unit rod techniques, despite patients in the present study having a greater mean pelvic obliquity (42° compared with 21° in the literature), a 78 % correction was still achieved, which is similar and, in certain instances, superior to the results of other published case series (78 % compared with 53 %).
Conclusions
Maximum-width (M-W) segmental sacropelvic fixation, comprising iliosacral screws and/or iliac screws, enables a superior correction of severe pelvic obliquity in patients with neuromuscular scoliosis.
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References
Thomson JD, Banta JV (2001) Scoliosis in cerebral palsy: an overview and recent results. J Pediatr Orthop 10:6–9
Hart DA, McDonald CM (1998) Spinal deformity in progressive neuromuscular disease: natural history and management. Phys Med Rehabil Clin N Am 9:213–232
McCarthy RE (1999) Management of neuromuscular scoliosis. Orthop Clin N Am 30:435–449
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
Thometz JG, Simon SR (1988) Progression of scoliosis after skeletal maturity in institutionalized adults who have cerebral palsy. J Bone Joint Surg (Am) 70:1290–1296
Bonnett C, Brown JC, Perry JJ et al (1975) Evolution of treatment of paralytic scoliosis at Rancho Los Amigos Hospital. JBJS (Am) 57:206–215
Benson ER, Thomson JD, Smith BG et al (1998) Results and morbidity in a consecutive series of patients undergoing spinal fusion for neuromuscular scoliosis. Spine 23:2308–2318
Westerlund LE, Gill SS, Jarosz TS et al (2001) Posterior-only unit rod instrumentation and fusion for neuromuscular scoliosis. Spine 26:1984–1989
Allen BL, Ferguson RL (1984) The Galveston technique of pelvic fixation with L-rod instrumentation of the spine. Spine 9:388–394
Comstock CP, Leach JPT, Wenger DR (1998) Scoliosis in total-body-involvement cerebral palsy: analysis of surgical treatment and patient and caregiver satisfaction. Spine 23:1412–1424
Gau YL, Lonstein JE, Winter RB et al (1991) Luque-Galveston procedure for correction and stabilization of neuromuscular scoliosis and pelvic obliquity: a review of 69 patients. J Spinal Disord 4:399–410
King AG, Thomas KA, Eiserloh HL 3rd et al (2000) Analysis of the STIF technique for spinopelvic fixation: clinical results in 19 patients with neuromuscular scoliosis. J Pediatr Orthop 20:667–676
Miladi LT, Ghanem IB, Draoui MM, Zeller RD, Dubousset JF (1997) Iliosacral screw fixation for pelvic obliquity in neuromuscular scoliosis: a long-term follow-up study. Spine 22:1722–1729
Lonstein JE, Akbarnia BA (1983) Operative treatment of spinal deformities in patients with cerebral palsy or mental retardation. J Bone Joint Surg (Am) 65:43–55
Dias RC, Miller F, Dabney K et al (1997) Revision spine surgery in children with cerebral palsy. J Spine Disord 10:132–144
Marchesi D, Arlet V, Stricker U et al (1997) Modification of the original Luque technique in the treatment of Duchenne’s neuromuscular scoliosis. J Pediatr Orthop 17:743–749
Arlet V, Marchesi D, Papin P et al (1999) The ‘MW’ sacropelvic construct: an enhanced fixation of the lumbosacral junction in neuromuscular pelvic obliquity. Eur Spine J 8:229–231
Maloney WJ, Rinsky LA, Gamble JG (1990) Simultaneous correction of pelvic obliquity, frontal plane and sagittal plane deformities in neuromuscular scoliosis using a unit rod with segmental sublaminar wires: a preliminary report. J Pediatr Orthop 10:742–749
Tsirikos AI, Chang WN, Shah SA et al (2003) Preserving ambulatory potential in pediatric patients with cerebral palsy who undergo spinal fusion using unit rod instrumentation. Spine 28:480–483
Wild A, Haak H, Kumar M et al (2001) Is sacral instrumentation mandatory to address pelvic obliquity in neuromuscular thoracolumbar scoliosis due to myelomeningocele? Spine 26:E325–E329
Winter S (1994) Preoperative assessment of the child with neuromuscular scoliosis. Orthop Clin N Am 25:239–245
Askin GN, Haller R, Hare N et al (1997) The outcome of scoliosis surgery in the severely physically handicapped child: an objective and subjective assessment. Spine 22:44–50
Cassidy C, Craig CL, Perry A et al (1994) A reassessment of spinal stabilization in severe cerebral palsy. J Pediatr Orthop 14:731–739
Basobas L, Mardjetko S, Hammerberg K et al (2003) Selective anterior fusion and instrumentation for the treatment of neuromuscular scoliosis. Spine 28:S245–S248
Huang MJ, Lenke LG (2001) Scoliosis and severe pelvic obliquity in a patient with cerebral palsy: surgical treatment utilizing halo-femoral traction. Spine 26:2168–2170
Whitaker C, Burton DC, Asher M (2000) Treatment of selected neuromuscular patients with posterior instrumentation and arthrodesis ending with lumbar pedicle screw anchorage. Spine 25:2312–2318
Yazici M, Asher MA, Hardacker JW (2000) The safety and efficacy of Isola-Galveston instrumentation and arthrodesis in the treatment of neuromuscular spinal deformities. J Bone Surg (Am) 82:524–543
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Awwad, W., Al-Ahaideb, A., Jiang, L. et al. Correction of severe pelvic obliquity using maximum-width segmental sacropelvic screw fixation: an analysis of 20 neuromuscular scoliosis patients. Eur J Orthop Surg Traumatol 25 (Suppl 1), 233–241 (2015). https://doi.org/10.1007/s00590-014-1458-4
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DOI: https://doi.org/10.1007/s00590-014-1458-4