Pedicle screw instrumentation with or without pelvic fixation in neuromuscular scoliosis: Outcome and complications in a series of 37 patients with a minimum 2-year follow-up

Stiel, Norbert; Özden, Jasmin; Ridderbusch, Karsten; Moritz, Menard; Kunkel, Philip; Gulati, Amit; Hagemann, Christian; Mladenov, Kiril; Stuecker, Ralf; Spiro, A. G.

doi:10.1016/j.surge.2019.11.007

Cited by 7 publications

(6 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2). 11–13,28 For patients presenting with minimal PO (<10 to 15 degrees), numerous authors have reported adequate PO correction without pelvic instrumentation 6,13,14,16,18,29–32. McCall and Hayes6 and Takaso et al14 demonstrated the durability of this correction, demonstrating maintenance of PO correction at long-term follow-up in their respective studies.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…These patients are medically complex, at high risk for perioperative complications, 33,34 and subject to numerous surgeries throughout their lifetime as a result of their underlying condition, regardless of their spinal status. Some studies suggest that fusion ending shy of the pelvis cannot correct nor maintain severe PO ( > 15 to 20 degrees) 9,13,14,16 and including pelvic instrumentation at index surgery reduces the need for revision surgery for loss of PO correction. 15,17 Further, when revising patients fused to L5 initially with extensions to the pelvis, there is a higher overall complication rate, risk of implant failure, pseudarthrosis, and revision surgery compared with patients in whom the pelvis was included in the initial operation.…”

Section: Consmentioning

confidence: 99%

See 2 more Smart Citations

When Should Instrumentation to the Pelvis be Considered in Minimally Ambulatory Adolescents With Neuromuscular Scoliosis?

Douleh¹,

Greig²,

Thompson³

et al. 2021

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

Introduction:The goal of neuromuscular scoliosis (NMS) surgery is to improve sitting balance, facilitate daily care, and alleviate pain. In nonambulatory patients, where sitting balance is key, fusion to the pelvis is usually required. However, in minimally ambulatory patients, fusion to the pelvis remains controversial, and there is considerable practice variability in this patient population. The purpose of this study is to evaluate and summarize the available evidence regarding fusion constructs in minimally ambulatory patients with NMS and to provide expert opinion regarding when fusion to the pelvis should be considered. Methods: A search of the English literature was performed using PubMed to identify papers pertaining to patients with NMS treated with instrumented posterior spinal fusion. Papers published before 2000, case reports, and level V evidence were excluded. Results: The authors identified 8 studies for review. The majority included both nonambulatory and minimally ambulatory patients. Structured review of the literature demonstrated fusion to the pelvis may allow for greater curve and pelvic obliquity correction, but it is also associated with increased blood loss and operative time. There is no evidence that fusing to the pelvis decreases ambulatory status in minimally ambulatory patients. Conclusions: In minimally ambulatory patients with NMS, fusion short of the pelvis may be considered in patients with adequate head control without the presence of hip subluxation or dislocation and when pelvic obliquity is <15 degrees. Fusion to the pelvis is recommended in patients who do not meet these criteria.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Consmentioning

confidence: 99%

See 1 more Smart Citation

When Should Instrumentation to the Pelvis be Considered in Minimally Ambulatory Adolescents With Neuromuscular Scoliosis?

Douleh¹,

Greig²,

Thompson³

et al. 2021

Journal of Pediatric Orthopaedics

View full text Add to dashboard Cite

show abstract

“…In surgical cases of preserved mobile segments, the patients maintain relative flexibility and able to hold a sitting position 4 , 16 . However, Akesen et al reported that spinopelvic fusion with iliac screws in neuromuscular scoliosis did not increase implant failure and helped achieve better functional results 17 .…”

Section: Discussionmentioning

confidence: 99%

“…Especially, pelvic fixation results in greater blood loss, longer operative time, and need for more extensive soft tissue dissection 19 . Pelvic fixation also increases vulnerability to infection and screw-related skin problems because the fusion for NMS was required to long-level fixation 14 – 16 . Our data showed group A detected highest complication rate of screw-related skin problem, which are one of the reasons to decision-making of no spinopelvic fixation in this study.…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiological efficacy of spino-pelvic fixation in the treatment of neuromuscular scoliosis

Yang

Kim

Chang

et al. 2023

Sci Rep

View full text Add to dashboard Cite

Pelvic fixation is performed to obtain proper coronal and sagittal alignment when the pelvic obliquity is more than 15º in patients with neuromuscular scoliosis (NMS). Since many NMS patients were wheelchair or bed-ridden status, there has been controversy on the effect of pelvic fixation. Therefore, the purpose of this study is to analyze the effects of pelvic fixation on correction of spinal deformity and quality of life (QoL) in NMS patients. A total of 77 NMS patients who underwent deformity correction were divided into three groups and retrospectively analyzed preoperatively, postoperatively, and at 2-year follow-up: pelvic fixation group (Group A, n = 16), fixed to S1 (Group B, n = 33), and fixed to L5 (Group C, n = 28). The correction rate of scoliosis was 60.0%, 58.0%, and 56.7% in groups A, B, and C, respectively, with no statistical difference (P > 0.05). The correction rate of pelvic obliquity was 61.3%, 42.8%, and 57.5% in respective groups A, B, and C, with no significance (P > 0.05). The correction loss of scoliosis and pelvic obliquity showed no statistical significance between three groups for 2-year follow-up (all Ps > 0.05). There were no significant differences regarding clinical outcomes and postoperative complications among the three groups (all Ps > 0.05). Therefore, pelvic fixation using iliac screws is not substantially influencing radiological and clinical outcomes in the patients with NMS.

show abstract

The indication of fusion to the pelvis in neuromuscular scoliosis is based on the underlying disease rather than on pelvic obliquity

Geiger,

Eberl,

Wirries

et al. 2023

Eur Spine J

View full text Add to dashboard Cite

Introduction The decision to instrument to L5 or ilium, in NMS, is usually based on radiologic factors, including pelvic obliquity (PO) > 15°, apex of curvature < L3, and Cobb angle > 60°. Since scoliosis in these patients is caused by a neurologic disease, we based our decision to stop at L5 on the presence of spasticity or flaccidity. Patients & Methods The senior author did 109 primary fusions in NMS. Of those with DMD or SMA only 16% were instrumented to the ilium. The main factor for our decision was the correction potential of the truncal shift and PO in the supine traction radiographs and the absence of severe spasticity. Results The 57 patients with DMD/SMA had a mean preoperative curvature of 68°, PO of 17°, and truncal shift of 20°. 74% should have been instrumented to the pelvis, but only 16% were. Those instrumented shorter as the rule, were corrected from 74° to 26° and had a postoperative PO of 8°. There was no significant difference in postoperative correction and PO compared to those instrumented to L5 on standard protocol. Subsequent extension to the pelvis was needed in 1 CP patient. There were no significant changes after 2 years. Of the 20 patients instrumented to the pelvis 11 had cerebral palsy and a preop curvature of 89°, a PO of 21° and a truncal shift of 25°. Discussion The decision on instrumentation length should take flexibility and disease into consideration. If the trunk is centred over the pelvis, deterioration will not occur in absence of spasticity.

show abstract

Pedicle screw instrumentation with or without pelvic fixation in neuromuscular scoliosis: Outcome and complications in a series of 37 patients with a minimum 2-year follow-up

Cited by 7 publications

References 24 publications

When Should Instrumentation to the Pelvis be Considered in Minimally Ambulatory Adolescents With Neuromuscular Scoliosis?

When Should Instrumentation to the Pelvis be Considered in Minimally Ambulatory Adolescents With Neuromuscular Scoliosis?

Clinical and radiological efficacy of spino-pelvic fixation in the treatment of neuromuscular scoliosis

The indication of fusion to the pelvis in neuromuscular scoliosis is based on the underlying disease rather than on pelvic obliquity

Contact Info

Product

Resources

About