The safety and efficacy of Isola-Galveston instrumentation and arthrodesisin the treatment of neuromuscular spinal deformities

Background: Implant systems that realign and stabilize a deformed spine con tinue to evolve. The purpose of the study of this case series was to determ ine the safety and effectiveness of a system designed to integrate hook, wi re, screw, and post anchors for the treatment of a wide spectrum of neuromu scular disorders associated with pelvic deformity or the potential for defo rmity. Methods: Forty-seven consecutive patients who had a spinal deformity that w as due to cerebral palsy or an upper motor-neuron cerebral palsy-like disea se (thirty-one patients), myelomeningocele (nine), Duchenne muscular dystro phy (four), or other disorders (three) were managed with Isola-Galveston in strumentation and arthrodesis, The average age at the time of the operation was fourteen years and three months (range, five years and four months to twenty-three years and nine months). Eight patients (17 percent) had an add itional anterior discectomy and arthrodesis without instrumentation, and th ree (6 percent) had an additional decancellation eggshell osteotomy, The fo rty-seven patients were followed for an average of forty-seven months (rang e, twenty-four to 100 months). The complications were tabulated to assess t he safety of the procedure, and the correction of each deformity was calcul ated to determine the efficacy. Results: There were no deaths, acute wound infections, or serious neurologi cal problems. Reoperation was necessary in five patients (11 percent). One reoperation was performed because of a delayed deep wound infection; one, b ecause of delayed sterile drainage; and one, for a pseudarthrosis repair: T he remaining two reoperations were done for removal of an implant because t he cephalad portion had become prominent, In addition to the pseudarthrosis that required a reoperation, there were three possible, pseudarthroses tha t did not require a reoperation (overall prevalence of pseudarthrosis, 9 pe rcent). Postoperative bracing was used for eleven patients (23 percent); it did not influence the rate of pseudarthrosis or possible pseudarthrosis. The average preoperative scoliosis of 70 degrees was corrected to 24 degree s (a 66 percent correction) at the time of the latest follow-up, and the av erage preoperative pelvic obliquity of 27 degrees was corrected to 5 degree s (an 81 percent correction). A survey of the patients, parents, and caregi vers indicated that 96 percent of them were satisfied or very satisfied wit h the result of the operation, Conclusions: Isola-Galveston instrumentation scents as safe and effective a s other types of instrumentation that have been studied in comparable serie s in the literature, Isola-Galveston instrumentation is probably more effec tive for the correction of pelvic obliquity and the maintenance of correcti on. Only a posterior procedure is used, and the instrumentation appears to decrease the need for an additional anterior approach. Spinal hook, wire, s crew, and post anchors have been successfully integrated into one posterior spinal implant system.