Posterior Multilevel Vertebral Osteotomy for Correction of Severe and Rigid Neuromuscular Scoliosis

Suh, Seung Woo; Modi, Hitesh N.; Yang, Jae-Hyuk; Song, Hae Ryong; Jang, Ki-Mo

doi:10.1097/brs.0b013e3181a028bc

Cited by 50 publications

(46 citation statements)

References 31 publications

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“…An anterior approach to the spine is not advocated in DMD patients as it can require lung deflation leading to respiratory complications and a higher blood loss when compared to a posterior only approach (54).…”

Section: Surgical Techniquesmentioning

confidence: 99%

Duchenne muscular dystrophy: the management of scoliosis

et al. 2016

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This study summaries the current management of scoliosis in patients with Duchenne Muscular Dystrophy.A literature review of Medline was performed and the collected articles critically appraised. This literature is discussed to give an overview of the current management of scoliosis within Duchenne Muscular Dystrophy.Importantly, improvements in respiratory care, the use of steroids and improving surgical techniques have allowed patients to maintain quality of life and improved life expectancy in this patient group.

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Section: Surgical Techniquesmentioning

confidence: 99%

Duchenne muscular dystrophy: the management of scoliosis

et al. 2016

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“…It has been described that, in cases of severe rigid pelvic obliquity and scoliotic curve, vertebral decancellation or multilevel vertebral osteotomies can be used to achieve better correction. These techniques can eliminate the need for a combined anterior and posterior approach and potentially decrease complications [20].…”

Section: Iliac Screwsmentioning

confidence: 99%

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

Chechik

Fishkin

Wientroub

et al. 2011

Journal of Children's Orthopaedics

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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.

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“…Patients with curves greater than 100°have an approximately 10% risk for neurologic compromise with curve correction [19]. To improve the accuracy of thoracic pedicle screws, various insertion techniques, such as the free-hand technique, fluoroscopy, computer-assisted surgery [1,12,15,17], intraoperative EMG [14,17,21,23], somatosensory evoked potentials, and MEP monitoring have been described. Image-guided techniques are expensive and time consuming.…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative neuromonitoring was performed with transcranial motor-evoked potentials (Tc-MEP) in all patients. Additionally, in 18 patients, multilevel vertebral osteotomies were performed for better correction of curves, but anterior release was not performed in any patient [23]. No intraoperative radiographs of the spine were obtained to check positioning of the pedicle screws.…”

Section: Methodsmentioning

confidence: 99%

Accuracy of Thoracic Pedicle Screw Using Ideal Pedicle Entry Point in Severe Scoliosis

Modi¹,

Suh²,

Hong³

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background The ideal pedicle entry point for the thoracic spine is described as the base of the superior facet at the junction of the lateral and middle thirds of the pedicle. Investigators have reported its accuracy in curves less than 90°. Questions/purposes Our aim was to measure the accuracy of this entry point for pedicle screw insertion in severe and rigid scoliotic curves. Patients and Methods We retrospectively measured the accuracy of thoracic pedicle screws in 26 patients with severe and rigid scoliosis (Cobb angle C 90°) inserted using the free-hand technique and the ideal pedicle entry point. Placements of thoracic pedicle screws were reviewed on postoperative CT scans, and the incidence and severity of penetration were determined. Screws penetrating medially up to 2 mm and laterally up to 4 mm were considered within the safe zone. Results One hundred sixty-eight (34.8%) of 482 inserted screws breached pedicle walls; 64 (13.2%) and 104 (21.6%) screws breached pedicle walls medially and laterally, respectively. Four hundred thirty-seven screws were within the safe zone, representing an accuracy rate of 90.7%. The accuracy rates of inserted screws in upper, middle, and lower thoracic pedicles were 93.4%, 87.7%, and 92%, respectively.

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Posterior Multilevel Vertebral Osteotomy for Correction of Severe and Rigid Neuromuscular Scoliosis

Abstract: This technique should be recommended because (1) it provides release of anterior column without anterior approach and (2) our results supports its superiority as a technique.

Cited by 50 publications

References 31 publications

Duchenne muscular dystrophy: the management of scoliosis

Duchenne muscular dystrophy: the management of scoliosis

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

Accuracy of Thoracic Pedicle Screw Using Ideal Pedicle Entry Point in Severe Scoliosis

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