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

Abstract

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.

The frontal and sagittal patterns of neuromuscular spine deformities depending on the nosological profile

“…On the one hand, scoliosis straightens better, but the other hand patents have more limited movement freedom, what can lead to a decrease in functional independence and quality of life. There are still heated debates now 19 .Most patients will have spinopelvic xation 1 .The exception is ambulatory patients with NMS with adequate head control, without hip subluxation or dislocation and small degree pelvic obliquity (< 15°), they may not need pelvis xation 20 .…”

Progressive scoliosis associated with microphthalmia with limb anomalies: A case report

“…It should be pointed out that the range of spinal correction and fixation in ambulatory patients with syndromic scoliosis remains controversial. [12] Previous studies have revealed that, especially in nonambulatory patients with neuromuscular scoliosis, extending instrumentation to the pelvis improves scoliosis correction and sitting balance if the angle of PO exceeds 10° to 15°. [13][14][15][16] In this case, the patient was ambulatory at the time of surgery; however, the nature of her progressive scoliosis had caused the PO angle to increase significantly.…”

Clinical Issues in Indication, Correction, and Outcomes of the Surgery for Neuromuscular Scoliosis: Narrative Review in Pedicle Screw Era

“…3 ) [ 33 ]. In a recent review article, fusion short of the pelvis was considered in patients with adequate head control without the presence of hip subluxation or dislocation and when pelvic obliquity is < 15° [ 34 ]. In our opinion, if pelvic obliquity is associated with coronal imbalance, especially C-type neuromuscular scoliosis, pelvic fixation should be performed considering the correction of the curve and postoperative coronal balance.…”

“…Although we can do the stable lumbosacral fixation, the selection between the mobility for the advantages in performing transfers, weight shifts, or rotational mobility, and the fusion for the correction of pelvic obliquity for sitting balance is questionable. Douleh et al [ 34 ] suggested adequate head control as a guide for L5–S1 preservation. This indication looks ideal considering proximal junctional problem.…”