Management of spinal cord injury–related scoliosis using pedicle screw–only constructs

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Almost all pediatric patients who incur a spinal cord injury (SCI) will develop scoliosis, and younger patients are at highest risk for curve progression requiring surgical intervention. Although the use of pedicle screws is increasing in popularity, their impact on SCI-related scoliosis has not been described. The authors retrospectively reviewed the radiographic outcomes of pedicle screw–only constructs in all patients who had undergone SCI-related scoliosis correction at a single institution.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Medical records and radiographs from Shriner's Hospital for Children–Philadelphia for the period between November 2004 and February 2011 were retrospectively reviewed.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Thirty-seven patients, whose mean age at the index surgery was 14.91 ± 3.29 years, were identified. The cohort had a mean follow-up of 33.2 ± 22.8 months. The mean preoperative coronal Cobb angle was 65.5° ± 25.7°, which corrected to 20.3° ± 14.4°, translating into a 69% correction (p &lt; 0.05). The preoperative coronal balance was 24.4 ± 22.6 mm, with a postoperative measurement of 21.6 ± 20.7 mm (p = 1.00). Preoperative pelvic obliquity was 12.7° ± 8.7°, which corrected to 4.1° ± 3.8°, translating into a 68% correction (p &lt; 0.05). Preoperative shoulder balance, as measured by the clavicle angle, was 8.2° ± 8.4°, which corrected to 2.7° ± 3.1° (67% correction, p &lt; 0.05). Preoperatively, thoracic kyphosis measured 44.2° ± 23.7° and was 33.8° ± 11.5° postoperatively. Thoracolumbar kyphosis was 18.7° ± 12.1° preoperatively, reduced to 8.1° ± 7.7° postoperatively, and measured 26.8° ± 20.2° at the last follow-up (p &lt; 0.05). Preoperatively, lumbar lordosis was 35.3° ± 22.0°, which remained stable at 35.6° ± 15.0° postoperatively.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Pedicle screw constructs appear to provide better correction of coronal parameters than historically reported and provide significant improvement of sagittal kyphosis as well. Although pedicle screws appear to provide good radiographic results, correlation with clinical outcomes is necessary to determine the true impact of pedicle screw constructs on SCI-related scoliosis correction.</jats:p></jats:sec>

Hip-Spine Syndrome in Patients With Spinal Cord Injuries: Hyperlordosis Associated With Severe Hip Flexion Contracture

“…Mayfield et al (10) observed that patients managed for a lumbar hyperlordosis deformity were associated with a secondary hip flexion contracture, and we believe further consideration must be made for these contractures potentially being the primary pathology. Hwang et al (14) reported an uncorrected LL despite spinal surgery, and in our opinion, this may possibly be due to untreated ITB contracturerelated problems. Currently, the literature is too sparse to draw any significant conclusions regarding the relationship between SCI-related hip and spine deformities.…”

“…To date, there have been no reports that exclusively manage the paraplegic SCI-associated hip deformity and exaggerated LL. Few have reported operative results of spinal deformities in SCI and poliomyelitis, of which most focus on scoliosis ( 14 ). Furthermore, despite the relationship between the hip and spine being briefly mentioned in the literature, the secondary effects of treating the spine by hip deformity correction have not been investigated.…”