Minimally Invasive Surgery for Neuromuscular Scoliosis

Results and Complications at a Minimal Follow-up of 5 Years

Mathilde Gaume, MD; Claudio Vergari, MD; Nejib Khouri, MD; Wafa Skalli, MD, PhD; Christophe Glorion, MD, PhD; Lotfi Miladi, MD

Disclosures

Spine. 2021;46(24):1696-1704. 

In This Article

Abstract and Introduction

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 maturitywas 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

Introduction

Neuromuscular scoliosis is caused by a disorder of the brain, spinal cord, or muscular system. Neuromuscular curves are often associated with trunk imbalance, pelvic obliquity, and kyphosis, starting to develop at an early age and usually worsen over time despite conservative treatment.[1] Common conditions associated with neuromuscular scoliosis are cerebral palsy, myelomeningocele, spinal muscular atrophy, and muscular dystrophy. Early posterior spine fusion (PSF) used to be performed for the most severe of them, with the risk of stunting trunk growth and concomitant effects on lung development. Arthrodesis provides a high complication rate, especially infections and hemorrhages requiring long intensive care unit stay.[2,3] Growth-sparing surgical procedures have therefore been developed to preserve spinal and thoracic growth and to postpone arthrodesis.[4,5] These techniques were first introduced by Harrington in 1962.[6] They became more and more popular during the two last decades with the advent of traditional growing rods (TGR). After initial surgery, some surgical procedures of rod lengthening are performed to achieve as spinal height as possible, followed by a PSF when the patient reaches skeletal maturity.[7,8] However, the complication rate can reach 40% to 73%[9–12] with these methods.

An original technique of bipolar instrumentation was developed as an alternative to TGR for the treatment of neuromuscular scoliosis.[13] The surgical approach was minimally invasive, since proximal and distal short incisions were performed thus preserving the intermediate area to avoid early fibrosis and autofusion. The results were maintained after 2-year follow-up with a 61% correction of the Cobb angle and 83% correction of the pelvic obliquity. The aim of this work was to evaluate the clinical and radiological outcomes of minimally invasive fusionless technique for neuromuscular scoliosis at a minimum of 5 years of follow-up.

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