Minimally Invasive Surgery for Neuromuscular Scoliosis: Results and Complications at a Minimal Follow-up of 5 Years

Abstract

Study Design. A prospective study.Objective. The aim of this study was to report the results of an alternative technique to growing rods (GR) for neuromuscular scoliosis using a minimally invasive fusionless surgery with a minimum of 5 years' follow-up. Summary of Background Data. Conservative treatment is not effective in progressive neuromuscular scoliosis. Early surgery using GR is increasingly advocated to control the deformity while preserving spinal and thoracic growth before arthrodesis. These techniques still provide a high rate of complications. Methods. The technique relies on a bilateral double rod sliding instrumentation anchored proximally by four hooks claws and distally to the pelvis by iliosacral screws through a minimally invasive approach. The clinical and radiological outcomes of 100 consecutive patients with neuromuscular scoliosis who underwent this fusionless surgery with a minimum follow-up of 5 years were reviewed. Results. 6.5 AE 0.7 years after initial surgery, six patients were lost of follow-up and 11 died of unrelated raison. Of the 83 remaining patients at latest follow-up, mean Cobb angle was stable to 35.08 which correspond to 61% correction of the initial deformation. Mean pelvic obliquity was 29.68 (0.38-80.08) preoperatively and 7.2 (0.28-23.58) at latest follow-up. Correction of the hyper kyphosis remained stable. Skeletal maturity was reached in 42 of 83 patients (50.6%). None of these patients has required spinal fusion. The global complication rate was 31.3%. Conclusion. The outcomes of this minimally invasive fusionless technique at 5 years follow-up showed a stable correction of spinal deformities and pelvic obliquity over time, with a reduced rate of complication. The arthrodesis was not required for all patients at skeletal maturity. This technique could be a good alternative to arthrodesis for neuromuscular scoliosis.

Bipolar Fusionless Versus Standard Fusion Surgery in Neuromuscular Scoliosis

“…The BFC allowing further growth of the spine is therefore indicated in immature patients, as confirmed by our own study, allowing early removal of bracing, which has been demonstrated to have a negative impact on the quality of life and treatment satisfaction while not avoiding curve progression 36,37 . Furthermore, the solidity of the BFC makes final spinal fusion unnecessary, preventing further surgical interventions in skeletally mature patients, as demonstrated by long-term studies and recent meta-analyses 17,33,35 …”

“…Some less invasive constructs exist for NMS treatment to decrease complication rates while maintaining adequate curve correction 10,15,16 . Among them, a 4-rod bipolar fusionless construct (BFC), which was strongly fixed to the upper thoracic spine and to the pelvis, made it possible to avoid final fusion and presented a low rate of mechanical complications (14%) even after 5 years of follow-up 10,17 . There is, however, a current lack of studies comparing clinical and radiologic perioperative outcomes between this technique and SPF for NMS.…”

Minimally Invasive Fusionless Surgery for Scoliosis in Spinal Muscular Atrophy: Long-term Follow-up Results in a Series of 59 Patients

“…MIFLS bipolar technique differs from TGR as it is definitive thanks to a solid construct relying on strong proximal and distal fixations. The stability of the results at long term and the absence of rod breakage made it possible to avoid the final arthrodesis for all patients, that was initially planned 33. This technique became the standard of surgical treatment for neuromuscular scoliosis in our department.…”

“…The stability of the results at long term and the absence of rod breakage made it possible to avoid the final arthrodesis for all patients, that was initially planned. 33 This technique became the standard of surgical treatment for neuromuscular scoliosis in our department. However, even if this construct is definitive, it remains evolutive as it allows a gradual correction of the spinal deformity thanks to further symmetric or asymmetric RL procedures if necessary, to improve the correction of residual spinal deformity or pelvic obliquity.…”

Novel Surgical Technique for Adolescent Idiopathic Scoliosis: Minimally Invasive Scoliosis Surgery

“…Nevertheless, several surgeons have been trying to apply MIS techniques for the correction of AIS, being eager to reduce surgical morbidities and bring cosmetic benefits. Moreover, efforts to reduce the surgical burden have extended to other types of deformities, such as neuromuscular scoliosis [ 18 , 19 ].…”