1. The surgical treatment aims to:
Outcomes 119 Patients with Neuromuscular Scoliosis treated with Spino-Pelvic Trans Iliac Fixation
A. Montanaro, F. Turturro, L. Labianca, F. Di Salvo, R. Hoedemaeker, A. Ferretti, U.O.C Orthopaedic and Traumatology Sant’Andrea Hospital, II Faculty of Medicine, Sapienza University of Rome
BACKGROUND
RESULTS
71 reported a complete documentation; 59 had F.U.> 2y (mean 8,7y)
36 males 23 females (mean age 15,3yo) - Mean Cobb angle was 68°(40°-110°)before and °(16°-60°)after surgery Mean loss of correction at follow up was 10°
22 DMD 27 SMA 10 CP Mean Pelvic obliquity angle was 16,6° before and
Follow up average 8,7 y ,7°after surgery
83% good to excellent to Bridwell’s test - All patients achieved sitting position within 7-10 days
after surgery after surgery
NEUROMUSCOLAR SCOLIOSIS TOPICS
•Early onset
•Rapid degenerative character
•Progression after ending growth
•Loss of functional capacity
•Pelvic obliquity
Conservative treatment can’t influence the scoliosis’ progression
(Cambridge, 1987 Forst, 1990 Reece, 1994 Heller, 2001)
The surgical treatment aims to:
Correct pelvic obliquity
Reduce the scoliosis and cyphosis
Correct chest deformity
Purpose: The m-STIF (modified spinopelvic transiliac fixation) technique for lumbosacral fusion was developed by the authors as an alternative to the well known STIF. The m-STIF tecnique doesn’t need a surgical preparation of gluteus allowing less blood and surgery time loosing.
The goal of our study is to evaluate the results of angle correction obteined with the m-STIF and to verify if there is any difference in outcomes with series in literature .
Mean Cobb angle pre,post and f.u.
Cobb angle.
Mean pelvic obliquity pre,post and f.u.
Pelvic obliquity
Materials and Method .Reviewed the records of 119 consecutive neuromuscolar patients with a progressive scoliosis who underwent spinal surgery. First clinical and X-ray of the spine was done at 3 months, 1 year and every 2 years after surgery. Follow-up > 2aa
Bridwell’s test used for subjective evaluation. Statistical Software (SPSS) was used to perform the statistical analysis. For all statistical comparison, a value of p < 0.05 was considered significant. Values were compared with literature too.
Fig. 3a-b RX pre-op and post-op. The red line shows the chest deformity pre-op and is compared with the green one that shows the chest deformity post-op(as it is in the fig.3b)
Fig. 4a-b before surgery
Fig. 4c-d follow-up.
PUBMED COMPARISON
Fig 4a
Fig 4b
Fig 4c
Fig 4d
% SCOLIOSIS CORRECTION:
Brook 61% OUR SERIES
King 60,5% %
Broachie-Adjei 49%
LOSS of CORRECTION at F.U.
Miladi 7% OUR SERIES
King 0,2% %
% PELVIC IMBALANCE CORRECTION:
Brook 63% OUR SERIES
King 83,5% 72%
Broachie-Adjei 53%
LOSS of CORRECTION at F.U.
Broachie-Adjei 21%OUR SERIES
King 17% 15%
Fig.1a: STIF.
Rods at 90° Final compression
of the sacroiliac joints is achieved by
tightening of the spherical nuts against mating washers placed on the outer table of the ilium.
Fig.1b: M- STIF.
Rods are bended of 100°-120° at short arm and filled 1cm laterally the sacroiliac joint. No nuts were used
Fig.2: Rods crossed at the end without cross link(A).
Parallel rods,with sublaminar wiring and cross link (B).
Parallel rods, cross-link in distraction and pedicle screws (C).
1991 A
Fig.2a
1995 B
CONCLUSION The STIF technique here described can provide a stable base for scoliosis correction and pelvic obliquity. Despite the severe coronal and sagittal plane curves in this group of patients, the results are similar to that reported in literature for Galveston technique, but with a minor surgeon care.
Fig.2b
2002 C
The linking of the rods, in distraction, increases the overall rigidity of the construct and facilitates compression of the sacroiliac joints.
distraction
Fig.1a
Fig.1b
Fig.2c
Surgical Tecnique
The spine is prepared in the usual manner for neuromuscular scoliosis, and sublaminar wires, hooks, or pedicle screws are attached according to a plan that will give optimum correction. In the m-STIF the insertion angle into the ilium gives more biomechanical stability to the row into the bone.
Fig 3a
Fig 3b