Advances in spinopelvic fixation may have improved correction for neuromuscular scoliosis

Although rigid construct fixation for deformity correction outperformed non-rigid construction for deformity correction in patients with neuromuscular scoliosis at final follow-up, researchers of this recently published retrospective chart and radiographic review found rigid construct fixation was a more expensive option. 

Researchers identified 80 patients who were treated between 1998 and 2012 with posterior spinal fusion to the pelvis for neuromuscular scoliosis and had a minimum 1-year follow-up. About 95% were non-ambulatory and most patients (55%) were identified as having cerebral palsy. The researchers defined non-rigid constructs as having greater than 50% sublaminar wire fixation with Galveston or iliac screw pelvic fixation, and rigid constructs were defined as having 50% or greater pedicle screw fixation with iliac or sacral alar iliac screw pelvic fixation.

Researchers noted 23 patients received non-rigid constructs and 57 patients received rigid constructs. There was no statistical difference in the pelvic obliquity or the preoperative Cobb angle between the rigid or non-rigid groups or in the immediate postoperative deformity correction.

The mean estimated cost for the rigid construct was significantly higher than the estimated cost for the non-rigid construct ($15,488 vs. $3,128), according to the study data. At final follow-up, the Cobb angle correction and pelvic obliquity was much greater in the rigid group compared with the non-rigid group.

“Loss of correction greater than 5° occurred within the non-rigid group in 65% of patients for Cobb angle and 57% for pelvic obliquity as compared with 23% and 21% within the rigid group, respectively (P < 0.001 and P = 0.002). Additionally, the final pelvic obliquity progressed to at least 5° greater than the preoperative deformity for 43% (10/23) of the non-rigid group as compared with 7% (4/57) of the rigid group (P < 0.001), demonstrating that non-rigid implants were not reliably able to maintain correction and prevent progressive deformity,” the researchers wrote in the study. – by Robert Linnehan

Source : Healio, 27th Jan 2016