Arnaud Dubory1, Manon Bachy1,2, Houssam Bouloussa1, Aurélien Courvoisier3, Baptiste Morel4, Raphaël Vialle5,6. 1. Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris6, 26, avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France. 2. University Department for Innovative Therapies in Musculoskeletal Diseases-Armand Trousseau Hospital, The MAMUTH Hospital, 26, avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France. 3. University Clinic of Paediatric Surgery, Paediatric Orthopaedics, Hôpital Couple-Enfant, Grenoble University Hospital, Joseph-Fourier University, BP 217, 38043, Grenoble Cedex 09, France. 4. Department of Pediatric Imaging, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris6, 26, avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France. 5. Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris6, 26, avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France. raphael.vialle@trs.aphp.fr. 6. University Department for Innovative Therapies in Musculoskeletal Diseases-Armand Trousseau Hospital, The MAMUTH Hospital, 26, avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France. raphael.vialle@trs.aphp.fr.
Abstract
PURPOSE: The primary goal of curve correction in neuromuscular patients is to restore coronal and sagittal trunk balance, including the pelvis, to maximize sitting balance. For several years, it has been a common practice to inject polymeric cement into osteoporotic bone through specially designed, perforated pedicle screws in an effort to enhance screw stability. Therefore, we started using the association of a spinopelvic fixation with S1 pedicle screw augmentation, using bisphenol-a-glycidyl dimethacrylate composite resin in neuromuscular patients with pelvic obliquity, technique in neuromuscular patients to improve pedicle screw stability of our pelvic construct. METHODS: Ten patients undergoing spinopelvic fixation for a neuromuscular spinal deformity were enrolled in the study. Clinical and radiographic data were analyzed and presented. Minimal follow-up took place at 6 months to assess early complications. RESULTS: Five patients were diagnosed with spastic quadriplegia secondary to cerebral palsy, four had Duchenne's muscular dystrophy, and one had a T5-level traumatic flaccid paraplegia. Preoperative PO ranged from 8° to 34° (mean 19.16°). Postoperative PO ranged from 0° to 6.3° (mean 1.6°). After surgery, all patients returned to a full-time sitting position between days 5 and 12 without the need for additional bracing. No mechanical failure of the construct was noted during follow-up. CONCLUSIONS: We used sacral pedicle screw augmentation as a reliable tool to strengthen spinopelvic fixation in neuromuscular scoliosis without increasing the intraoperative morbidity. In our practice, sacral screw augmentation can definitely enhance PO correction obtained by a posterior procedure.
PURPOSE: The primary goal of curve correction in neuromuscular patients is to restore coronal and sagittal trunk balance, including the pelvis, to maximize sitting balance. For several years, it has been a common practice to inject polymeric cement into osteoporotic bone through specially designed, perforated pedicle screws in an effort to enhance screw stability. Therefore, we started using the association of a spinopelvic fixation with S1 pedicle screw augmentation, using bisphenol-a-glycidyl dimethacrylate composite resin in neuromuscular patients with pelvic obliquity, technique in neuromuscular patients to improve pedicle screw stability of our pelvic construct. METHODS: Ten patients undergoing spinopelvic fixation for a neuromuscular spinal deformity were enrolled in the study. Clinical and radiographic data were analyzed and presented. Minimal follow-up took place at 6 months to assess early complications. RESULTS: Five patients were diagnosed with spastic quadriplegia secondary to cerebral palsy, four had Duchenne's muscular dystrophy, and one had a T5-level traumatic flaccid paraplegia. Preoperative PO ranged from 8° to 34° (mean 19.16°). Postoperative PO ranged from 0° to 6.3° (mean 1.6°). After surgery, all patients returned to a full-time sitting position between days 5 and 12 without the need for additional bracing. No mechanical failure of the construct was noted during follow-up. CONCLUSIONS: We used sacral pedicle screw augmentation as a reliable tool to strengthen spinopelvic fixation in neuromuscular scoliosis without increasing the intraoperative morbidity. In our practice, sacral screw augmentation can definitely enhance PO correction obtained by a posterior procedure.
Authors: Hyun Bae; Michael Shen; Philip Maurer; Walter Peppelman; William Beutler; Raymond Linovitz; Erik Westerlund; Timothy Peppers; Isador Lieberman; Choll Kim; Federico Girardi Journal: Spine (Phila Pa 1976) Date: 2010-09-15 Impact factor: 3.468