Pelvic fixation is not always necessary in children with cerebral palsy scoliosis treated with growth-friendly instrumentation

Li, Ying; Swallow, Jennylee; Gagnier, Joel; Smith, John T.; Murphy, Robert F.; Sponseller, Paul D.; Cahill, Patrick J.

doi:10.1007/s43390-022-00474-z

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…In our study, the ambulatory DSA patients had a mean PO that remained stable at most recent follow-up. Li et al 11 previously showed that preoperative PO <10 degrees and L5 tilt ≤ 10 degrees may be the indications to exclude the pelvis in children with cerebral palsy and EOS treated with distraction-based growth-friendly implants. Similar criteria could be followed for ambulatory hypotonic NMS patients, as our ambulatory DSA patients had a mean preindex PO of 5 degrees and L5 tilt of 9 degrees.…”

Section: Discussionmentioning

confidence: 99%

“…10 L5 tilt ≤ 10 degrees and PO <10 degrees have also been reported as possible indications to exclude the pelvis in children with cerebral palsy and scoliosis treated with distraction-based growthfriendly instrumentation. 11 Indications to exclude the pelvis in children with hypotonic NMS undergoing treatment with growth-friendly implants has not been studied.…”

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confidence: 99%

“…A prior study showed that exclusion of the pelvis at the time of posterior spinal fusion in patients with flaccid NMS with preoperative L5 tilt <15 degrees and curve apex at L2 or higher resulted in good radiographic outcomes with a low complication rate 10. L5 tilt ≤10 degrees and PO <10 degrees have also been reported as possible indications to exclude the pelvis in children with cerebral palsy and scoliosis treated with distraction-based growth-friendly instrumentation 11. Indications to exclude the pelvis in children with hypotonic NMS undergoing treatment with growth-friendly implants has not been studied.…”

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Comparison of Distal Spine Anchors and Distal Pelvic Anchors in Children With Hypotonic Neuromuscular Scoliosis Treated With Growth-friendly Instrumentation

Ahmady

Rosenthal

Abraham

et al. 2023

Journal of Pediatric Orthopaedics

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Background: Lower preoperative pelvic obliquity (PO) and L5 tilt have been associated with good radiographic outcomes when the fusion ended short of the pelvis in children with neuromuscular scoliosis (NMS). Our purpose was to identify indications to exclude the pelvis in children with hypotonic NMS treated with growth-friendly instrumentation. Methods: This was a multicenter retrospective review. Children with spinal muscular atrophy and muscular dystrophy treated with dual traditional growing rod, magnetically controlled growing rod, or vertical expandable prosthetic titanium rib with minimum 2-year follow-up after the index surgery were identified. Results: A total of 125 patients met the inclusion criteria. Thirty-eight patients had distal spine anchors (DSAs) and 87 patients had distal pelvic anchors (DPAs) placed at the index surgery. Demographics and length of follow-up were similar between the groups but there was a greater percentage of DPA patients who were nonambulatory [79 patients (91%) vs. 18 patients (47%), P<0.0001]. Preindex radiographic measures were similar except the DSA patients had a lower PO (11 vs. 19 degrees, P=0.0001) and L5 tilt (8 vs. 12 degrees, P=0.001). Postindex and most recent radiographic data were comparable between the groups. There was no difference in the complication and unplanned returns to the operating room rates. Subanalysis of the DSA group based on ambulatory status showed similar radiographic measures except the ambulatory patients had a lower PO at all time points (preindex: 5 vs. 16 degrees, P=0.011; postindex: 6 vs. 10 degrees, P=0.045; most recent follow-up: 5 vs. 14 degrees, P=0.028). Only 1 ambulatory DSA patient had a PO ≥10 degrees at most recent follow-up compared with 6 nonambulatory DSA patients. Three (8%) DSA patients, all nonambulatory, underwent extension of their instrumentation to the pelvis. Conclusions: Pelvic fixation should be strongly considered in nonambulatory children with hypotonic NMS treated with growth-friendly instrumentation. At intermediate-term follow-up, revision surgery to include the pelvis was rare but DSAs do not seem effective at maintaining control of PO in nonambulatory patients. DSA and DPA were equally effective at maintaining major curve control, and complication and unplanned returns to the operating room rates were similar. Level of Evidence: Level III—therapeutic.

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Comparison of Distal Spine Anchors and Distal Pelvic Anchors in Children With Hypotonic Neuromuscular Scoliosis Treated With Growth-friendly Instrumentation

Ahmady

Rosenthal

Abraham

et al. 2023

Journal of Pediatric Orthopaedics

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Distal level in scoliosis surgery for non-ambulatory patients with cerebral palsy: is L5 an option? A case series study

et al. 2023

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Pelvic Fixation for Non-Ambulatory Patients with Neuromuscular Scoliosis Treated with Magnetically Controlled Growing Rods—A 4-Year Comparison of Two Different Fixation Methods

Heuer,

Stuecker,

Stuecker

et al. 2024

JCM

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Background/Objectives: This study aims to analyze the efficacy and safety of the two pelvic fixation systems, S-hooks (SH) and lumbar-sacral-alar-iliac (SAI) screws, when used in association with magnetically controlled growing rods (MCGRs) in non-ambulatory children with severe neuromuscular scoliosis (NMS). Methods: Forty-one patients were retrospectively examined and subdivided corresponding to ilium hook fixation or SAI screws. The major curve correction (%) and pelvic obliquity (PO) correction (%) were assessed utilizing scoliosis plain film radiographs over time. Complications and unplanned return to the operating room (UPROR) were recorded. Patient-specific pre- and postoperative values were included in a backward stepwise regression model to assess UPROR. Results: Mean age at index intervention was 9.4 years. Preoperative main curve was 81° and PO was 22°. 21 and 20 patients were categorized into the SH and SAI subgroups, respectively. Initial curve correction was significantly better in the SAI subgroup (63 vs. 42% in the SH, p = 0.045), while PO correction was equally good. Curve and PO correction were maintained throughout the follow-up period of 55 months. UPROR rate was 38% in the SH subgroup, and 5% in the SAI subgroup (p = 0.010). Regression analysis identified postoperative curve correction as predictive value for UPROR (p = 0.006). Conclusions: SAI screw fixation has a low UPROR rate and achieves superior curve correction. S-hooks are a viable option to correct PO and NMS in children with high operative risk to reduce operative time, but revision surgery is not uncommon.

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Pelvic fixation is not always necessary in children with cerebral palsy scoliosis treated with growth-friendly instrumentation

Cited by 3 publications

References 17 publications

Comparison of Distal Spine Anchors and Distal Pelvic Anchors in Children With Hypotonic Neuromuscular Scoliosis Treated With Growth-friendly Instrumentation

Comparison of Distal Spine Anchors and Distal Pelvic Anchors in Children With Hypotonic Neuromuscular Scoliosis Treated With Growth-friendly Instrumentation

Distal level in scoliosis surgery for non-ambulatory patients with cerebral palsy: is L5 an option? A case series study

Pelvic Fixation for Non-Ambulatory Patients with Neuromuscular Scoliosis Treated with Magnetically Controlled Growing Rods—A 4-Year Comparison of Two Different Fixation Methods

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