A new pelvic rod system for the surgical correction and fixation of pelvic obliquity in pediatric neuromuscular scoliosis

Abstract

Purpose To describe surgical outcomes using the new device in pediatric neuromuscular scoliosis. Methods All patients with neuromuscular disorders requiring surgery with pelvic fixation for the correction of scoliosis in the period 2002-2009 were operated by the new pelvic rod fixation device. Coronal and sagittal alignment before and after surgery until the latest follow-up were evaluated by standard X-rays. Intraoperative and postoperative complications were recorded. Results All 18 study patients (mean age at surgery 15 years, range 10-27) achieved solid fusion at a mean follow-up of 41 months. The coronal Cobb angle improved from 82°± 31°(range 36-168) to 33°± 25°at the last follow-up (range 9-95 months) (P \ 0.0001). Pelvic obliquity improved from 19°± 6°(range 10-30) to 5°± 5°( range 0-14) (P \ 0.0001). Early complications included pneumonia, urinary tract infection, disseminated intravascular coagulation (DIC), and hypovolemic shock. Three patients required debriding and received prolonged antimicrobial therapy for deep wound infection (none required implant removal). At the latest follow-up, no patient complained of lumbar pain or worsening of ambulatory status or level of activity.Conclusion Surgery employing the new pelvic rod fixation device allowed solid fusion and fixation with significant correction of multiplanar deformity, but the complication rate was high.

Early Pelvic Fixation Failure in Neuromuscular Scoliosis

“…5,[9][10][11][12][13] Outcomes with these varying techniques, with respect to correction, maintenance of correction and minimization of implant-related complications, are also good. 5,[9][10][11][12][13] Outcomes with these varying techniques, with respect to correction, maintenance of correction and minimization of implant-related complications, are also good.…”

Posterior spinal fusion to sacrum in non-ambulatory hypotonic neuromuscular patients: Sacral rod/bone graft onlay method

“…The tendency in spinal deformity surgery with stabilization to L 5 or to the pelvis in neuromuscular patients (most of whom are non-ambulatory) is to get very good initial correction of both scoliosis and pelvic obliquity with a slight loss of correction over the next several years. Examples reporting mean values pre-operatively, post-operatively, and at latest follow-up include: (Cotrel–Dubousset to pelvis, 18 patients) scoliosis 70° to 38° to 41°; pelvic obliquity 19° pre-operatively in 13, 9 improved 22° to 11°, and 4 worsened 13° to 16° [ 10 ]; (Harrington–Luque, most Luque to pelvis with modified Moe fusion, 101) scoliosis 84° to 40° with mean loss of correction of 7°; pelvic obliquity 21° to 11° with mean loss of correction of 3° [ 29 ]; (Luque rod/Galveston, 31) scoliosis 48° to 16.7° to 22°; pelvic obliquity 19.8° to 7.2° to 11.6° [ 30 ]; [Luque single unit rod, pedicle screws, 74 (25 to sacrum or pelvis)] scoliosis 53.5° to 27.3° to 39°; pelvic obliquity 20° to 10.8° to 16° [ 35 ]; (pedicle screws and iliac screws, 20) scoliosis 44° to 10°; pelvic obliquity 14° to 3° [ 14 ]; (Jackson intrasacral fixation, hybrid above, 56) scoliosis 58.5° to 22.3° to 23.5°, pelvic obliquity-improved [ 15 ]; (sublaminar wires group A, sublaminar wires and pedicle screws group B, pedicle screws group C, 43) scoliosis changes group A: 50° to 15.7° to 21.6°, group B: 17.8° to 3.6° to 6.7°, and group C: 25.8° to 5.5° to 8.9° [ 33 ]; (pedicle screw instrumentation, 27; iliac screws to pelvis, 18) scoliosis (entire 27) 79.8° to 30.2° to 31.9°; pelvic obliquity for cases extended to pelvis 22.2° to 11.2° to 13.4° [ 21 ]; (Luque–Galveston, 93) scoliosis 72° to 33° to 36° [ 20 ]; (new pelvic rod system, 18) scoliosis 82.3° to 30.9° to 33.4°; pelvic obliquity 19.3° to 5° to 5° [ 6 ].…”

“…Many recommend fusion to the pelvis in all non-ambulatory patients having spinal fusion [ 6 , 15 , 17 , 18 , 29 ], while those fusing only to L 5 recommend doing so in those with early or milder deformities such as scoliosis <40°, pelvic obliquity <10° (or 15°) and the apex of the curve at L 1 (or L 2 ) and above [ 21 , 25 , 27 , 30 , 34 ]. Alman and Kim [ 27 ] fused 38 DMD patients to L 5 but noted subsequent increase of pelvic obliquity in all of at least 10°, while none of 10 fused to the pelvis showed any increase.…”

“…This approach has been attempted since the beginning of spinal deformity surgery, even prior to the use of metallic stabilization [1][2][3][4]. With the use of internal fixation, many methods for extending fusion to the sacrum have been attempted, mainly by placing the metal rods within the sacrum and/or ilium or attaching them to bone by screw or hook fixation [1,[5][6][7][8][9][10][11][12][13][14][15][16][17][18]. As rigidity increased from extensive thoracolumbar stabilization, increasing stress was placed on the lumbosacral junction and on pelvic fixation devices, especially if limited to the sacrum.…”

Disseminated Intravascular Coagulation in Pediatric Scoliosis Surgery: A Systematic Review

“…Patients who had neuromuscular scoliosis presented with a history of cerebral palsy, 8,9 mild distal weakness, 4 Rett syndrome, 10 and a myelomeningocele with a T10 sensory level. 9 Tumors causing the scoliotic curve were from a patient with familial osteochondromatosis 6 and a cavernous hemangioma.…”