POSTERIOR SPINAL-FUSION IN NEUROMUSCULAR SCOLIOSIS USING A TIBIAL STRUT GRAFT - RESULTS OF A LONG-TERM FOLLOW-UP

Study Design. Risks and benefits of using a tibial graft for posterior spinal fusion in neuromuscular scoliosis were evaluated in a long-ter m follow-up study. A consecutive series of 72 patients underwent poste rior spinal fusion for neuromuscular scoliosis. Objectives. Radiologic outcome was assessed to evaluate the quality of the spinal fusion. Pa tients were followed serially to detect donor site complications. Mean follow-up was 17 years and 8 months (minimum: 6 years, 6 months). Sum mary of Background Data. Mean age of the patients at the time of surge ry was 15 years. Progression of the curvature was minimal at last foll ow-up (mean progression at last follow-up: lumbar curve, 4.5-degrees; thoracic curve, 5.3). Concerning donor site complications, four patien ts had a leg length discrepancy of less than 2 cm at last follow-up. T his complication was related to tibial overgrowth at the donor site. M ethods. Solid fusion was defined in this long-term study as the absenc e of modification of the radiologic aspect at last follow-up in additi on to the presence of a massive contiguous trabecular fusion mass. Res ults. The fusion appeared to be solid in all patients. No obvious pseu darthrosis could be documented. The constant successful outcome differ s significantly from spinal fusion that uses bank bone. The absence of stress fracture was correlated to the low level of constraint in this essentially nonambulatory population. Conclusions. This experience in dicates that the tibial graft deserves consideration in posterior spin al fusion for neuromuscular scoliosis.