Spine fusion in patients with spinal muscular atrophy.

Aprin, Horomozan; Bowen, J. Richard; Gd, MacEwen; Hall, Jennifer.

doi:10.2106/00004623-198264080-00008

Cited by 91 publications

(43 citation statements)

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“…The literature regarding the surgical management of spinal deformity in flaccid neuromuscular disorders (SMA and DMD) suggests that bilateral instrumentation and fusion to either L5 or sacrum is the most effective [1,6,8,12,18,29,30,33,34,42,43] and multiple fixation points such as sublaminar wires are preferred. Marchesi et al [26] selected the modified Galveston technique by inserting two diverging iliac rods over the S1 screw, which subsequently secured tightly with sublaminar wires.…”

Section: Discussionmentioning

confidence: 99%

“…Other reported benefits of scoliosis surgery include an improvement in sitting comfort [30,32,35] because the pelvic obliquity, which renders sitting uncomfortable (if not impossible), is corrected by surgery. Other benefits include improved sitting balance, [1,20,35] a stable spine [34] and trunk, [16] esthetic improvement, [20,27] improvement in sitting height, [1,30] relief from back pain [5] and greater ease with which patients could be transported by relatives [20]. The improved sitting balance resulted in greater functional freedom of the arms [1,27,32] as they could now be used for purposes other than supporting the trunk.…”

Section: Discussionmentioning

confidence: 99%

“…Other benefits include improved sitting balance, [1,20,35] a stable spine [34] and trunk, [16] esthetic improvement, [20,27] improvement in sitting height, [1,30] relief from back pain [5] and greater ease with which patients could be transported by relatives [20]. The improved sitting balance resulted in greater functional freedom of the arms [1,27,32] as they could now be used for purposes other than supporting the trunk. Almost all the patients in other studies [20,32,35] were of the opinion that surgery had been worthwhile.…”

Section: Discussionmentioning

confidence: 99%

“…Using pedicle screws is an effective method to correct the rotational component of the deformity. Some authors have advocated the use of pelvic fixation for pelvic obliquity, especially in neuromuscular scoliosis [1,6,8]; however, others have warned about the risk of complications with, it such as screw impingement and ulceration, pain and pressure sores, etc. [5,36,37,40].…”

Section: Introductionmentioning

confidence: 99%

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Treatment and complications in flaccid neuromuscular scoliosis (Duchenne muscular dystrophy and spinal muscular atrophy) with posterior-only pedicle screw instrumentation

et al. 2009

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Literature has described treatment of flaccid neuromuscular scoliosis using different instrumentation; however, only one article has been published using posterior-only pedicle screw fixation. Complications using pedicle screws in paralytic neuromuscular scoliosis has not been described before. To present results and complications with posterior-only pedicle screws, a retrospective study was carried out in 27 consecutive patients with flaccid neuromuscular scoliosis (Duchenne muscular dystrophy and spinal muscular atrophy), who were operated between 2002 and 2006 using posterior-only pedicle screw instrumentation. Immediate postoperative and final followup results were compared using t test for Cobb angle, pelvic obliquity, thoracic kyphosis and lumbar lordosis. Perioperative and postoperative complications were noted from the hospital records of each patient. Complications, not described in literature, were discussed in detail. Average follow-up was 32.2 months. Preoperative, immediate postoperative and final follow-up Cobb angle were 79.8°, 30.2°(63.3% correction, p \ 0.0001) and 31.9°, respectively; and pelvic obliquity was 18.3°, 8.9°(52% correction, p \ 0.0001) and 8.9°. Postoperative thoracic kyphosis remained unchanged from 27.6°to 19.9°(p = 0.376); while lumbar lordosis improved significantly from ?15.6°t o -22.4°lordosis (p = 0.0002). Most patients had major to moderate improvement in postoperative functional and ambulatory status compared to the preoperative status. Thirteen (48.1%) perioperative complications were noted with five major complications (four respiratory in the form of hemothorax or respiratory failure that required ventilator support and one death) and eight minor complications (three UTI, two atelectasis, two neurological and one ileus). Postoperatively, we noted complications, such as coccygodynia with subluxation in 7, back sore on the convex side in 4 and dislodging of rod distally in 1 patient making a total of 12 (44.4%) postoperative complications. Of 12 postoperative complications, 6 (50%) required secondary procedure. We conclude that although flaccid neuromuscular scoliosis can be well corrected with posterior-only pedicle screw, there is a high rate of associated complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment and complications in flaccid neuromuscular scoliosis (Duchenne muscular dystrophy and spinal muscular atrophy) with posterior-only pedicle screw instrumentation

et al. 2009

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“…He stated that the patients seemed to experience relief from fatigue and an improvement in general physical well being. In a study of 22 patients with spinal muscular atrophy fused with Harrington instrumentation, Aprin et al [1] found no change in the ability to perform tasks involving daily hygiene, dressing and eating, but sitting balance was improved for most of them and the self-rated results were mostly positive. Brown et al [5] presented a study of gross motor activities pre-and postoperatively in patients with spinal muscular atrophy.…”

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confidence: 99%

Activities and functional assessment 1 year after spinal fusion for paralytic scoliosis

Larsson

Aaro

Öberg

1999

European Spine Journal

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The results of spinal fusion in patients with paralytic deformities are usually presented as the correction of the deformity. When evaluating the surgical results in such patients, it is advantageous to classify the patients into subgroups because of the varying dysfunction and disabilities. The aim of this study was to evaluate the effect of spinal fusion in patients with paralytic scoliosis in relation to function in terms of Impairments, activities in terms of Disabilities, and dependence in terms of Handicaps 1 year postoperatively, with emphasis on subgroups. A total of 94 patients with paralytic scoliosis and 18 different diagnoses were evaluated 1 year after surgery. The patients were classified according to whether or not they could understand verbal instructions. The patients were also grouped according to the Scoliosis Research Society classification of diagnoses. A set of instruments was used with the variables classified according to WHO's International Classification of Impairments, Disabilities, and Handicaps (ICIDH). This consists of the patient's/relative's motives for surgery, persistent skin discoloration, ambulating or use of wheelchair, use of a brace, sitting balance, weight distribution on a sitting surface, angle of scoliosis, reaching, pain estimation, activities of daily living (ADL) Klein and Bell, care given, time spent resting, and seating supports. The set of instrument also included a follow-up questionnaire comprising 12 different areas, where the patients/relatives assessed the results of surgery. The study showed that spinal fusion in paralytic scoliosis led to showed improvements in the whole group of patients at the Impairment level in the angle of scoliosis, sitting balance, weight distribution, and reduced number of patients with persistent skin discoloration, and at the Handicap level in reduced time for resting during the day, reduced number of seating supports in the wheelchair, and in the use of a brace. Most of the parameters were unchanged. The results in the subgroups were almost the same as in the whole group, although pain and reaching at the Impairment level, and ADL at the Disability level, could not be measured in the patients who were unable to understand verbal instructions. The subjectively assessed results showed that seating posture was ranked positively irrespective of the motive for surgery. The study showed that the patients with paralytic scoliosis maintained or improved their function and level of independence in terms of Impairment and Handicap 1 year postoperatively. The subjective results assessed by the patients/relatives also showed a positive outcome of surgery. Weight distribution on a seating surface was improved, but still uneven, and with respect to better sitting balance and increasing time sitting in a wheelchair, this can involve a risk for pressure sores and needs further investigation. When introducing outcomes including the Disability level, one must take the importance of homogeneity in the groups into consideration.

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