Surgical and Functional Results of Spine Fusion in Spinal Muscular Atrophy

Brown, John C.; Zeller, John L.; Swank, Susan M.; Furumasu, Jan; Warath, Sandra

doi:10.1097/00007632-198907000-00020

Cited by 72 publications

(26 citation statements)

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“…The literature regarding the surgical management of spinal deformity in flaccid neuromuscular disorders (SMA and DMD) suggests that bilateral instrumentation and fusion to either L5 or sacrum is the most effective [1,6,8,12,18,29,30,33,34,42,43] and multiple fixation points such as sublaminar wires are preferred. Marchesi et al [26] selected the modified Galveston technique by inserting two diverging iliac rods over the S1 screw, which subsequently secured tightly with sublaminar wires.…”

Section: Discussionmentioning

confidence: 99%

“…Using pedicle screws is an effective method to correct the rotational component of the deformity. Some authors have advocated the use of pelvic fixation for pelvic obliquity, especially in neuromuscular scoliosis [1,6,8]; however, others have warned about the risk of complications with, it such as screw impingement and ulceration, pain and pressure sores, etc. [5,36,37,40].…”

Section: Introductionmentioning

confidence: 99%

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Treatment and complications in flaccid neuromuscular scoliosis (Duchenne muscular dystrophy and spinal muscular atrophy) with posterior-only pedicle screw instrumentation

et al. 2009

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Literature has described treatment of flaccid neuromuscular scoliosis using different instrumentation; however, only one article has been published using posterior-only pedicle screw fixation. Complications using pedicle screws in paralytic neuromuscular scoliosis has not been described before. To present results and complications with posterior-only pedicle screws, a retrospective study was carried out in 27 consecutive patients with flaccid neuromuscular scoliosis (Duchenne muscular dystrophy and spinal muscular atrophy), who were operated between 2002 and 2006 using posterior-only pedicle screw instrumentation. Immediate postoperative and final followup results were compared using t test for Cobb angle, pelvic obliquity, thoracic kyphosis and lumbar lordosis. Perioperative and postoperative complications were noted from the hospital records of each patient. Complications, not described in literature, were discussed in detail. Average follow-up was 32.2 months. Preoperative, immediate postoperative and final follow-up Cobb angle were 79.8°, 30.2°(63.3% correction, p \ 0.0001) and 31.9°, respectively; and pelvic obliquity was 18.3°, 8.9°(52% correction, p \ 0.0001) and 8.9°. Postoperative thoracic kyphosis remained unchanged from 27.6°to 19.9°(p = 0.376); while lumbar lordosis improved significantly from ?15.6°t o -22.4°lordosis (p = 0.0002). Most patients had major to moderate improvement in postoperative functional and ambulatory status compared to the preoperative status. Thirteen (48.1%) perioperative complications were noted with five major complications (four respiratory in the form of hemothorax or respiratory failure that required ventilator support and one death) and eight minor complications (three UTI, two atelectasis, two neurological and one ileus). Postoperatively, we noted complications, such as coccygodynia with subluxation in 7, back sore on the convex side in 4 and dislodging of rod distally in 1 patient making a total of 12 (44.4%) postoperative complications. Of 12 postoperative complications, 6 (50%) required secondary procedure. We conclude that although flaccid neuromuscular scoliosis can be well corrected with posterior-only pedicle screw, there is a high rate of associated complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment and complications in flaccid neuromuscular scoliosis (Duchenne muscular dystrophy and spinal muscular atrophy) with posterior-only pedicle screw instrumentation

et al. 2009

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“…Aprin et al 17 , também utilizando hastes de Harrington, mostraram a dificuldade da evolução pós-operatória de seus pacientes e os possíveis danos à função motora que poderiam ser causados devido ao uso prolongado de órteses. Brown et al 24 , comparando os sistemas de Luque e Harrington, mostraram índice de perda de correção e complicações pós-operatórias muito maiores com o sistema de Harrington. Riddick e Winter 15 , utilizando o sistema de Harrington, obtiveram cerca de 40% de complicações, sendo a pseudoartrose a mais freqüente, além de insuficiência respiratória e alterações neurológi-cas.…”

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“…Riddick e Winter 15 , utilizando o sistema de Harrington, obtiveram cerca de 40% de complicações, sendo a pseudoartrose a mais freqüente, além de insuficiência respiratória e alterações neurológi-cas. O uso do instrumental de Luque e, recentemente, do sistema de Cotrel Dubousset, têm permitido mobilização precoce, eliminando a necessidade do uso de gesso ou órteses no pós-operatório 24 .…”

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Tratamento cirúrgico da escoliose na amiotrofia espinhal progressiva

Roso

Bitu

Zanoteli

et al. 2003

Arq. Neuro-Psiquiatr.

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RESUMO -Objetivo: Descrever os resultados imediatos e tardios da cirurgia para correção de escoliose em pacientes com amiotrofia espinhal progressiva (AEP). Método: 14 pacientes com AEP submetidos a cirurgia para escoliose foram selecionados para análise retrospectiva dos prontuários e radiografias, assim como para exame radiográfico e aplicação de um questionário na consulta final. O tempo médio de seguimento foi de 22 meses. A escoliose média pré-operatória foi de 78,4° pelo método de Cobb. Todos os pacientes apresentavam obliqüidade pélvica (média de 25,5°) e 11 apresentavam cifose. A média de idade à época da cirurgia foi de 12 anos e 3 meses. Em 12 pacientes foi realizada artrodese via posterior com instrumental de Luque-Galveston, e em 2 com instrumental de Cotrel-Dubousset. Resultados: Foi obtida correção no pós-operatório imediato de 64,3% da escoliose, 36,4% da cifose e 70,9% da obliqüidade pélvica. As complicações foram fístula liquórica e infecção precocemente em um caso; e tardiamente soltura da amarria de T1, em dois casos. Houve perda média de correção no final do seguimento de 0,26° da escoliose e de 1,28° da obliqüidade pélvica. Os pais e os pacientes referiram boa melhora em relação aos aspectos estéticos, postura, equilíbrio para sentar e cuidados de higiene, assim como das intercorrências respiratórias. Conclusão: A cirurgia para escoliose na AEP tem impacto satisfatório quanto à estética, qualidade de vida e função respiratória dos pacientes, com mínima perda da correção obtida com o tempo e com poucas complicações.PALAVRAS-CHAVE: amiotrofia espinhal progressiva, escoliose, artrodese de coluna, tratamento ortopédico, doenças neuromusculares. Surgical treatment of scoliosis in spinal muscular atrophyABSTRACT -Objective: To describe the early and late postoperative data from SMA patients with surgical procedure. Method: Clinical data and radiographic imaging from 14 SMA patients with surgical treatment of scoliosis were reviewed, and all were reassessed clinically with new spinal radiographs and a questionnaire. The mean follow-up were 22 months. The mean preoperative Cobb angle was 78.4°. All patients presented pelvic obliquity (mean 25.5°) and 11 had cifosis. The mean age at time of surgery was 12 years and 3 months. All patients were treated with posterior spinal fusion with Luque-Galveston instrumentation in 12 and CotrelDubousset instrumentation in 2. Results: The average curve correction at the immediate postoperative was 64.3% for scoliosis and 36.4% for cifosis, with the pelvic obliquity correction of the 70.9%. The complications were liquoric fistula and infection earlier in one case, and lately wire looseness of T1 in 2 patients. It was detected mean lost of the correction at the final assessment of the 0.26° of the scoliosis and the 1.28° of the pelvic obliquity. Relatives and the patients related good improvement regarding to esthetic aspects, posture balance, body care, as well as respiratory problems. Conclusion: The spinal fusion for scoliosis in SMA patients has a satisfactory i...

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“…In a study of 22 patients with spinal muscular atrophy fused with Harrington instrumentation, Aprin et al [1] found no change in the ability to perform tasks involving daily hygiene, dressing and eating, but sitting balance was improved for most of them and the self-rated results were mostly positive. Brown et al [5] presented a study of gross motor activities pre-and postoperatively in patients with spinal muscular atrophy. Thirty-four patients were spinal corrected with Harrington instrumentation and six patients with Luque segmental spinal instrumentation.…”

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confidence: 99%

Activities and functional assessment 1 year after spinal fusion for paralytic scoliosis

Larsson

Aaro

Öberg

1999

European Spine Journal

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The results of spinal fusion in patients with paralytic deformities are usually presented as the correction of the deformity. When evaluating the surgical results in such patients, it is advantageous to classify the patients into subgroups because of the varying dysfunction and disabilities. The aim of this study was to evaluate the effect of spinal fusion in patients with paralytic scoliosis in relation to function in terms of Impairments, activities in terms of Disabilities, and dependence in terms of Handicaps 1 year postoperatively, with emphasis on subgroups. A total of 94 patients with paralytic scoliosis and 18 different diagnoses were evaluated 1 year after surgery. The patients were classified according to whether or not they could understand verbal instructions. The patients were also grouped according to the Scoliosis Research Society classification of diagnoses. A set of instruments was used with the variables classified according to WHO's International Classification of Impairments, Disabilities, and Handicaps (ICIDH). This consists of the patient's/relative's motives for surgery, persistent skin discoloration, ambulating or use of wheelchair, use of a brace, sitting balance, weight distribution on a sitting surface, angle of scoliosis, reaching, pain estimation, activities of daily living (ADL) Klein and Bell, care given, time spent resting, and seating supports. The set of instrument also included a follow-up questionnaire comprising 12 different areas, where the patients/relatives assessed the results of surgery. The study showed that spinal fusion in paralytic scoliosis led to showed improvements in the whole group of patients at the Impairment level in the angle of scoliosis, sitting balance, weight distribution, and reduced number of patients with persistent skin discoloration, and at the Handicap level in reduced time for resting during the day, reduced number of seating supports in the wheelchair, and in the use of a brace. Most of the parameters were unchanged. The results in the subgroups were almost the same as in the whole group, although pain and reaching at the Impairment level, and ADL at the Disability level, could not be measured in the patients who were unable to understand verbal instructions. The subjectively assessed results showed that seating posture was ranked positively irrespective of the motive for surgery. The study showed that the patients with paralytic scoliosis maintained or improved their function and level of independence in terms of Impairment and Handicap 1 year postoperatively. The subjective results assessed by the patients/relatives also showed a positive outcome of surgery. Weight distribution on a seating surface was improved, but still uneven, and with respect to better sitting balance and increasing time sitting in a wheelchair, this can involve a risk for pressure sores and needs further investigation. When introducing outcomes including the Disability level, one must take the importance of homogeneity in the groups into consideration.

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Surgical and Functional Results of Spine Fusion in Spinal Muscular Atrophy

Cited by 72 publications

References 0 publications

Treatment and complications in flaccid neuromuscular scoliosis (Duchenne muscular dystrophy and spinal muscular atrophy) with posterior-only pedicle screw instrumentation

Treatment and complications in flaccid neuromuscular scoliosis (Duchenne muscular dystrophy and spinal muscular atrophy) with posterior-only pedicle screw instrumentation

Tratamento cirúrgico da escoliose na amiotrofia espinhal progressiva

Activities and functional assessment 1 year after spinal fusion for paralytic scoliosis

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