Pelvic Tilt in Neuromuscular Disorders

Frischhut, B.; Krismer, Martin; Stoeckl, B.; Landauer, Franz; Auckenthaler, Th.

doi:10.1097/01202412-200010000-00003

Cited by 27 publications

(30 citation statements)

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“…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.…”

Section: Methodsmentioning

confidence: 99%

“…Every other vertebra in the main lumbar region and every second or third vertebra in the upper thoracic region were instrumented. The average number of pedicle screws used was 16 (14)(15)(16)(17)(18)(19)(20) per patient. Locally harvested autologous bone was mixed with allograft for the interarticular and interlaminar fusion including the lumbosacral junction.…”

Section: Methodsmentioning

confidence: 99%

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Scoliosis correction with pedicle screws in Duchenne muscular dystrophy

et al. 2007

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This report describes the spinal fixation with pedicle-screw-alone constructs for the posterior correction of scoliosis in patients suffering from Duchene muscular dystrophy (DMD). Twenty consecutive patients were prospectively followed up for an average of 5.2 years (min 2 years). All patients were instrumented from T3/T4 to the pelvis. Pelvic fixation was done with iliac screws similar to Galveston technique. The combination of L5 pedicle screws and iliac screws provided a stable caudal foundation. An average of 16 pedicle screws was used per patient. The mean total blood loss was 3.7 l, stay at the intensive care unit was 77 h and hospital stay was 19 days. Rigid stabilisation allowed immediate mobilisation of the patient in the wheel chair. Cobb angle improved 77% from 44°to 10°, pelvic tilt improved 65% from 14°to 3°. Lumbar lordosis improved significantly from 20°to 49°, thoracic kyphosis remained unchanged. No problems related to iliac fixation, no pseudarthrosis or implant failures were observed. The average percentage of predicted forced vital capacity (%FVC) of the patients was 55% (22-94%) preoperatively and decreased to 44% at the last follow-up. There were no pulmonary complications. One patient with a known cardiomyopathy died intraoperatively due to a sudden cardiac arrest. The rigid primary stability with pedicle screws allowed early mobilisation of the patients, which helped to avoid pulmonary complications.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Scoliosis correction with pedicle screws in Duchenne muscular dystrophy

et al. 2007

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“…Pelvic obliquity associated with scoliosis in DMD continues to pose one of the most challenging instrumentation problems there is [3,10,27]. Instrumentation and fusion to the sacrum/pelvis has been a mainstay in the treatment of spinal deformity in DMD since the development of intrailiac post and recommended to prevent and/or correct pelvic obliquity [1,9].…”

Section: Discussionmentioning

confidence: 99%

“…However, controversy remains concerning the necessity of extending the implant constructs and fusion to the sacrum/pelvis [23,30,38]. In addition, pelvic fixation has certain disadvantages, including increased blood loss, longer operative time and technical difficulty [5,10,25,36]. In addition, the sacrum and the pelvis in patients with DMD are often small and osteoporotic [4,16].…”

Section: Discussionmentioning

confidence: 99%

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Can the caudal extent of fusion in the surgical treatment of scoliosis in Duchenne muscular dystrophy be stopped at lumbar 5?

et al. 2010

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Instrumentation and fusion to the sacrum/pelvis has been a mainstay in the surgical treatment of scoliosis in Duchenne muscular dystrophy (DMD) and is recommended to correct pelvic obliquity. The caudal extent of instrumentation and fusion in the surgical treatment of scoliosis in DMD has remained a matter of considerable debate, and there have been few studies on the use of segmental pedicle screw instrumentation for this pathology. From 2004 to 2007, a total of 28 patients with DMD underwent segmental pedicle screw instrumentation and fusion only to L5. Assessment was performed clinically and with radiologic measurements. All patients had a curve with the apex at L2 or higher preoperatively. Preoperative coronal curve averaged 74°, with a postoperative mean of 14°, and 17°at the last follow-up. The pelvic obliquity improved from 17°pre-operatively to 6°postoperatively, and 6°at the last follow-up. Good sagittal plane alignment was recreated after surgery and maintained long term. In 23 patients with a preoperative L5 tilt of less than 15°, the pelvic obliquity was effectively corrected to less than 10°and maintained by adequately addressing spinal deformity, while five patients with a preoperative L5 tilt of more than 15°had a postoperative pelvic obliquity of more than 15°. Segmental pedicle screw instrumentation and fusion to L5 was effective and safe in patients with DMD scoliosis with a minimal L5 tilt (\15°) and a curve with the apex at L2 or higher, both initially and long term, obviating the need for fixation to the sacrum/pelvis. Segmental pedicle screw instrumentation and fusion to L5 was safe and effective in patients with DMD scoliosis with stable L5/ S1 articulation as evidenced by a minimal L5 tilt of less than 15°, even though pelvic obliquity was significant. There was no major complication. With rigid segmental pedicle screw instrumentation, the caudal extent of fusion in the treatment of DMD scoliosis should be determined by the degree of L5 tilt. This method in appropriate patients can be a viable alternative to instrumentation and fusion to the sacrum/pelvis in the surgical treatment of DMD scoliosis.

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Hip

Cerebral Palsy

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The hip joint is the largest joint in the body and is the joint that causes the most problems both from a functional perspective and at the level of walking, sitting, and lying in children with cerebral palsy (CP). Hips in children with CP are normal at birth, and the problems develop slowly as the children grow and deform under the influence of abnormal forces caused by the CP. A second group of children with CP do not actually develop deformity; however, the infantile shape of their proximal femur does not resolve because there is not enough normal force present. In summary, these children develop contractures and increased abnormal forces that lead to dislocation and dysplasia, or alternatively, they fail to resolve the infantile torsional malalignment. After addressing the concerns of equinus contractures in children with CP, hip problems are the next main area of interest to orthopaedists treating these children. The treatment of hip problems has the largest literature base in the area of orthopaedic management of CP. A review of the abstract listings in the National Library of Medicine revealed 496 references published from 1963 to 2000 that address hip problems in children with CP. Although the literature is extensive, much of it does not include any standardized control or standardized radiographic measurements and has a poor description of specific patterns. A substantial body of this literature addresses the natural history of the problem of hip dysplasia, and its etiology has been fairly well understood. The evaluation of treatment outcomes suffers especially from poor categorization, poor standard evaluation procedures, and, most of all, very poor long-term follow-ups. Spastic HipsHip problems in children with CP first need to be divided by children's level of tone into either spastic children or those children who are hypotonic. The spastic (hypertonic) group should also include children with movement disorders such as athetosis and dystonia. The hypertonic hips can be subdivided further by the direction of the dysplasia or the abnormal force into posterosuperior, anterior, inferior and, additionally, by several contracture patterns that may be independent of or concurrent with dysplastic hips. These contracture patterns include windblown hips and hyperabducted hips. The hypotonic hips in children with CP are a little more diffuse and are harder to further categorize.

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Pelvic Tilt in Neuromuscular Disorders

Cited by 27 publications

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Scoliosis correction with pedicle screws in Duchenne muscular dystrophy

Scoliosis correction with pedicle screws in Duchenne muscular dystrophy

Can the caudal extent of fusion in the surgical treatment of scoliosis in Duchenne muscular dystrophy be stopped at lumbar 5?

Hip

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