RESULTS AND MORBIDITY IN A CONSECUTIVE SERIES OF PATIENTS UNDERGOING SPINAL-FUSION FOR NEUROMUSCULAR SCOLIOSIS

Study Design. A retrospective clinical and radiographic review. Object ives. To provide current data on the results and complications of pati ents who have undergone spinal fusion for neuromuscular scoliosis at a center with physicians experienced in there types of cases. Summary o f Background Data. The reported complication rate in the management of neuromuscular scoliosis ranges from 44% to 62% in the recent literatu re. This literature is that of 1991 or earlier reflecting operative te chniques of the mid-1980s, and it has been used to argue against the e fficacy of neuromuscular spinal fusions. Methods. A retrospective char t and radiographic review of 50 consecutive spinal fusions for neuromu scular scoliosis was preformed at Connecticut Children's Medical Cente r between January 1990 and January 1994. The three most common diagnos es were spastic quadriplegic cerebral palsy (20 patients), myelomening ocele (13 patients), and muscle disease (8 patients). There were 38 po sterior spinal fusions including two kyphectomies and 12 anteroposteri or spinal fusions. The Luque-Galveston technique was used in 39 of 50 patients. The average age at surgery was 13 years and 6 months, with a n average follow-up of 40 months (minimum, 24 months). Results. Before surgery, the mean major scoliosis measured 72 degrees, with mean best ben or traction view of 35 degrees. At most recent follow-up, the mea n scoliosis magnitude was 25 degrees (mean correction, 65%). There wer e 17 minor complications in 14 patients and three major complications in 14 patients and three major complications (deep would infections) i n three myelomeningocele patients. Rod breakage was noted in two patie nts, one of whom had an asymptomatic pseudarthrosis. There were no neu rologic complications or deaths, and none of the complications affecte d the final results. Conclusions. The data in the current study suppor t the authors' belief that with current surgical techniques and periop erative management in an experienced center, the results for patients undergoing spinal fusion for neuromuscular scoliosis have been improve d, and major complications have been minimized.