Lumbosacral fusion in children and adolescents using the modified sacral bar technique

Between 1986 and 1995 10 patients who were 9 to 18 years of age underwent p osterior spinal fusion and instrumentation to the pelvis for correction of spinal deformity using the modified sacral bar technique at the authors' in stitution. Etiologies of the spinal deformity included congenital scoliosis , cerebral palsy, myelomeningocele, neurofibromatosis, and postlaminectomy kyphosis, Indications for pelvic instrumentation were progressive scoliosis of the lower lumbar spine, pelvic obliquity greater than 15 degrees, and d ysraphic posterior elements. Five of the patients had prior spinal surgery. Five patients had a prior or a planned pelvic osteotomy, Nine of the patie nts achieved lumbosacral fusion without an additional procedure. Major comp lications included loss of pelvic fixation in two patients, and a dural lea k and a wound infection in another patient with myelomeningocele, Mean scol iotic curve correction was from 71.9 degrees to 34.5 degrees at final follo wup, Lumbar lordosis essentially was unchanged. Pelvic obliquity was correc ted from a mean of 20.5 degrees preoperatively to a mean of 7.6 degrees at final followup, The modified sacral bar technique was selected for fusion t o the sacrum because of planned or prior pelvic osteotomies, prior posterio r spinal fusion and instrumentation, sacral dysraphism, or local anatomic a nomalies. The modified sacral bar technique proved to be an effective techn ique in these patients.