Treatment of selected neuromuscular patients with posterior instrumentation and arthrodesis ending with lumbar pedicle screw anchorage

Study Design. This is a retrospective analysis of 23 patients with severe n euromuscular spinal deformity treated with posterior instrumentation and fu sion ending in the lumbar spine. Objectives. The purposes of this study were to determine the safety and eff icacy of stopping posterior instrumentation constructs in the lumbar spine wiht pedicle screw anchorage. Summary of Background Data. There are sparse data in the peer-reviewed lite rature regarding indications and outcomes in patients with neuromuscular di sorders for instrumented fusion ended short of the pelvis with trans pedicu lar fixation. Methods. The average age of patients at surgery was 18.4 years (range, 10-6 1 years). Additional anterior disc discectomy and fusion were performed in four patients with large, stiff curves. No patient received anterior instru mentation. Criteria for exclusion of the pelvis from the fusion were less t han 15 degrees of pelvic obliquity as a result of a compensatory curve belo w the major curve(s), the absence of problematic lower extremity contractur es, and, often, the potential for ambulation. Process and clinical outcome and complications were analyzed. Results. Radiographic follow-up was available in 21 patients at an average of 62 months (range, 24-110 months) after surgery. Their average Cobb angle was 71 degrees before surgery, 25 degrees after surgery (64% correction), and 32 degrees at follow-up (54% correction). Their average spinal-pelvic o bliquity was 6 degrees before surgery, 5 degrees after surgery, and 6 degre es at follow-up. The average lower instrumented vertebra was lumbar 3.7. Cl inical follow-up was available for all 23 patients for an average of 61 mon ths (range, 24-110 months). There were no perioperative deaths, deep wound infections, pseudarthroses, or instrument failures. Outcomes based on respo nses to questionnaires completed by patient, parent, or caregiver were high ly satisfactory in 20 patients (87%), satisfactory in 2 patients (9%) and n either satisfactory nor unsatisfactory in 1 patient (4%). Conclusion. Posterior instrumentation and arthrodesis using lumbar lower in strumented vertebra pedicle screw anchorage can be performed safely and eff ectively, in selected patients patients with scoliosis and minimal pelvic o bliquity.