Treatment and complications in flaccid neuromuscular scoliosis (Duchenne muscular dystrophy and spinal muscular atrophy) with posterior-only pedicle screw instrumentation
- 3 November 2009
- journal article
- research article
- Published by Springer Science and Business Media LLC in European Spine Journal
- Vol. 19 (3), 384-393
- https://doi.org/10.1007/s00586-009-1198-z
Abstract
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 follow-up 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° to −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.Keywords
This publication has 50 references indexed in Scilit:
- Scoliosis correction with pedicle screws in Duchenne muscular dystrophyEuropean Spine Journal, 2007
- Surgical treatment of spinal deformities in Duchenne muscular dystrophy: a long term follow-up studyEuropean Spine Journal, 2004
- Selective Anterior Fusion and Instrumentation for the Treatment of Neuromuscular ScoliosisSpine, 2003
- The 'MW' sacropelvic construct: an enhanced fixation of the lumbosacral junction in neuromuscular pelvic obliquityEuropean Spine Journal, 1999
- Early complications of spinal pedicle screwEuropean Spine Journal, 1997
- Long-term results of spine surgery in Duchenne muscular dystrophyNeuromuscular Disorders, 1996
- Surgical Treatment of Scoliosis in a Spinal Muscular Atrophy PopulationSpine, 1990
- Long-term Follow-up of Spinal Fusion in Spinal Muscular AtrophyPublished by Ovid Technologies (Wolters Kluwer Health) ,1986
- Spinal Fusion in Duchenneʼs Muscular DystrophySpine, 1982
- Spinal Deformities in Patients With Spinal Muscle AtrophySpine, 1982