MW construct in fusion for neuromuscular scoliosis

Abstract

Key points• Correction of pelvic obliquity in neuromuscular scoliosis is a surgical challenge.• There are numerous instrumentation techniques to achieve spinopelvic fixation in these patients.• The MW construct may be a superior instrumentation technique for the correction of pelvic obliquity and Cobb angles in neuromuscular scoliosis. Mini AbstractThe MW construct is a newly described means of achieving spinopelvic fixation in neuromuscular scoliosis. It has been theorized that this construct may provide for superior correction of pelvic obliquity in neuromuscular patients. Our study retrospectively examines this theory by comparing the results of posterior spinal fusion using the new MW technique to matched controls undergoing surgery utilizing the Galveston construct.

Scoliosis correction with pedicle screws in Duchenne muscular dystrophy

“…Just recently Caroll et al reported their experience with the 'MW' sacropelvic construct, first introduced by Arlet in 1999 [4]. They found a superior correction of the screw based sacropelvic fixation compared with the traditional Galvestone technique (60% vs. 33%) [10]. We prefer taking the L5 pedicle for screw fixation for the caudal foundation, as the L5 pedicles are smaller than the S1 pedicles and thus offer better screw fixation.…”

“…Pedicle-screw-alone constructs using a stainless steel implant were used in all patients. The mean age at operation was 14 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19) years. The age at wheel-chair bound averaged 10 (7-14) years.…”

Pelvic fixation for neuromuscular scoliosis deformity correction

“…Pelvic obliquity correction is finally accomplished with compression and distraction at the lumbosacral level. The original description of the technique proposed to add a crosslink in distraction in the low lumbar area, but this addition is probably not mandatory if pedicle screws are used at the lumbar levels [82,83]. The final appearance of the construct is an "M" on the posteroanterior radiograph and a "W" on axial reconstruction.…”

“…Carroll et al reported a 61 % reduction of pelvic obliquity in a series of 6 neuromuscular patients at 3 months of follow-up [83]. While it has been suggested that the average rate of correction of pelvic obliquity is 80 % using the construct, this is not currently supported by a peer-review publication.…”

“…Most of them are retrospective reviews and control groups are often heterogenous; the traditional Galveston technique represents the most frequently used control group [52,73,83,88,[102][103][104]. A retrospective study of 16 patients reported increased intraoperative and immediate postoperative failure of fixation of sacral screws (44%) and iliosacral screws (28%) compared to Galveston fixation (0 %).…”