Jonathan H Phillips1, James P Gutheil, D Raymond Knapp. 1. Orlando Regional Healthcare Systems, Medical Education Faculty Practice, Pediatric Orthopaedics, Orlando, FL 32806, USA. Jonathan.Phillips@orhs.org
Abstract
STUDY DESIGN: A retrospective review of children with neuromuscular scoliosis treated at our institution with posterior spinal fusion and instrumentation including iliac screws. OBJECTIVES: To determine the safety and effectiveness of iliac screws in neuromuscular scoliosis constructs. SUMMARY OF BACKGROUND DATA: The Galveston technique has been a standard method of impacting rods in the iliac wings to provide anchorage for neuromuscular scoliosis constructs. Numerous studies have shown the increased strength of constructs using screws as part of segmental spinal instrumentation. The ideal method of caudal anchorage is still unclear, and the role of iliac screws has yet to be defined. METHODS: The medical records and radiographs of 50 patients with neuromuscular scoliosis treated with a modified Luque-Galveston posterior spinal fusion and instrumentation technique were reviewed. The instrumentation was anchored to the pelvis via iliac screws: Group A constructs included 2 screws; Group B constructs included 4 screws. The radiographs were analyzed for Cobb angle and pelvic obliquity before surgery and after surgery. Complications were recorded, including infections and implant-related problems. RESULTS: The average curve correction was 48%. The average pelvic tilt correction was 59%. Complications included 4 deep infections requiring reoperation (8%), 10 screw-related complications (7 in Group A, 3 in the Group B), and 12 non-screw-related implant complications (11 in the Group A, 1 in the Group B). CONCLUSIONS: The use of screw fixation in the ilium as a means of spinopelvic anchorage is safe and effective in the treatment of neuromuscular scoliosis. The use of 2 screws in each iliac wing provides more stable fixation with fewer implant-related complications than using a single screw.
STUDY DESIGN: A retrospective review of children with neuromuscular scoliosis treated at our institution with posterior spinal fusion and instrumentation including iliac screws. OBJECTIVES: To determine the safety and effectiveness of iliac screws in neuromuscular scoliosis constructs. SUMMARY OF BACKGROUND DATA: The Galveston technique has been a standard method of impacting rods in the iliac wings to provide anchorage for neuromuscular scoliosis constructs. Numerous studies have shown the increased strength of constructs using screws as part of segmental spinal instrumentation. The ideal method of caudal anchorage is still unclear, and the role of iliac screws has yet to be defined. METHODS: The medical records and radiographs of 50 patients with neuromuscular scoliosis treated with a modified Luque-Galveston posterior spinal fusion and instrumentation technique were reviewed. The instrumentation was anchored to the pelvis via iliac screws: Group A constructs included 2 screws; Group B constructs included 4 screws. The radiographs were analyzed for Cobb angle and pelvic obliquity before surgery and after surgery. Complications were recorded, including infections and implant-related problems. RESULTS: The average curve correction was 48%. The average pelvic tilt correction was 59%. Complications included 4 deep infections requiring reoperation (8%), 10 screw-related complications (7 in Group A, 3 in the Group B), and 12 non-screw-related implant complications (11 in the Group A, 1 in the Group B). CONCLUSIONS: The use of screw fixation in the ilium as a means of spinopelvic anchorage is safe and effective in the treatment of neuromuscular scoliosis. The use of 2 screws in each iliac wing provides more stable fixation with fewer implant-related complications than using a single screw.