Treatment of neuromuscular scoliosis with posterior-only pedicle screw fixation

BACKGROUND To determine whether posterior-only approach using pedicle screws in neuromuscular scoliosis population adequately addresses the correction of scoliosis and maintains the correction over time. METHODS Between 2003 and 2006, 26 consecutive patients (7 cerebral palsy, 10 Duchenne muscular dystrophy, 5 spinal muscular atrophy and 4 others) with neuromuscular scoliosis underwent posterior pedicle screw fixation for the deformity. Preoperative, immediate postoperative and final follow-up Cobb's angle and pelvic obliquity were analyzed on radiographs. The average age of the patients was 17.5 years (range, 8-44 years) and the average follow-up was 25 months (18-52 months). RESULTS Average Cobb's angle was 78.53 degrees before surgery, 30.70 degrees after surgery (60.9% correction), and 33.06 degrees at final follow-up (57.9% correction) showing significant correction (p < 0.0001). There were 9 patients with curves more than 90 degrees showed an average pre-operative, post operative and final follow up Cobb's angle 105.67 degrees , 52.33 degrees (50.47% correction) and 53.33 degrees (49.53% correction) respectively and 17 patients with curve less than 90 degrees showed average per operative, post operative and final follow up Cobb's angle 64.18, 19.24(70% correction) and 21.41(66.64 correction); which suggests statistically no significant difference in both groups (p = 0.1284). 7 patients underwent Posterior vertebral column resection due to the presence of a rigid curve. The average spinal-pelvic obliquity was 16.27 degrees before surgery, 8.96 degrees after surgery, and 9.27 degrees at final follow-up exhibited significant correction (p < 0.0001). There was 1 poliomyelitis patient who had power grade 3 in lower limbs pre-operatively, developed grade 2 power post-operatively and gradually improved to the pre-operative stage. There was 1 case of deep wound infection and no case of pseudo-arthrosis, instrument failures or mortality. CONCLUSION Results indicate that in patients with neuromuscular scoliosis, acceptable amounts of curve correction can be achieved and maintained with posterior-only pedicle screw instrumentation without anterior release procedure.