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° before surgery, 30.70° after surgery (60.9% correction), and 33.06° at final follow-up (57.9% correction) showing significant correction (p < 0.0001). There were 9 patients with curves more than 90° showed an average pre-operative, post operative and final follow up Cobb's angle 105.67°, 52.33° (50.47% correction) and 53.33° (49.53% correction) respectively and 17 patients with curve less than 90° 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° before surgery, 8.96° after surgery, and 9.27° 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 pseud-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.