Minimally Invasive Surgery for Neuromuscular Scoliosis: Results and Complications at a Minimal Follow-up of 5 Years

Abstract

Study Design. 

A prospective study.

Objective. 

The aim of this study was to report the results of an alternative technique to growing rods (GR) for neuromuscular scoliosis using a minimally invasive fusionless surgery with a minimum of 5 years’ follow-up.

Summary of Background Data. 

Conservative treatment is not effective in progressive neuromuscular scoliosis. Early surgery using GR is increasingly advocated to control the deformity while preserving spinal and thoracic growth before arthrodesis. These techniques still provide a high rate of complications.

Methods. 

The technique relies on a bilateral double rod sliding instrumentation anchored proximally by four hooks claws and distally to the pelvis by iliosacral screws through a minimally invasive approach. The clinical and radiological outcomes of 100 consecutive patients with neuromuscular scoliosis who underwent this fusionless surgery with a minimum follow-up of 5 years were reviewed.

Results. 

6.5 ± 0.7 years after initial surgery, six patients were lost of follow-up and 11 died of unrelated raison. Of the 83 remaining patients at latest follow-up, mean Cobb angle was stable to 35.0° which correspond to 61% correction of the initial deformation. Mean pelvic obliquity was 29.6° (0.3°–80.0°) preoperatively and 7.2 (0.2°–23.5°) at latest follow-up. Correction of the hyper kyphosis remained stable. Skeletal maturity

was reached in 42 of 83 patients (50.6%). None of these patients has required spinal fusion. The global complication rate was 31.3%.

Conclusion. 

The outcomes of this minimally invasive fusionless technique at 5 years follow-up showed a stable correction of spinal deformities and pelvic obliquity over time, with a reduced rate of complication. The arthrodesis was not required for all patients at skeletal maturity. This technique could be a good alternative to arthrodesis for neuromuscular scoliosis.

Level of Evidence: 3

In Brief

This minimally invasive fusionless technique for neuromuscular scoliosis showed a stable correction of spinal deformities and pelvic obliquity with a minimum of 5 years follow-up. The global complication rate was 31.3%. Arthrodesis was not required for all patient. This technique could be a good alternative to arthrodesis for neuromuscular scoliosis.