ABSTRACT

Scoliosis due to neuropathic or myopathic disorders is called neuropathic scoliosis. Neuromuscular scoliosis are presented with pelvic obliquity, sagittal and coronal trunk imbalance, wide curve and collapsing spine. The aim of surgical treatment is obtain and maintain sagittal and coronal balance to avoid collapsed spine which usually leads to loss of sitting balance and rapid decrease in respiratory capacity. We present our results of posterior only surgery for neuromuscular scoliosis.

We retrospectively reviewed the radiographic and clinical data of 32 (12 female, 20 male) patients with neuromuscular scoliosis surgically treated at our institution. Diagnoses were Duchenne muscular dystrophy (5), myopathy (8), spinal muscular atrophy (4), meningomyelocel (5), Freidreichʼs ataxia (1), neurofibromatosis (1), fascioscapulohumeral dystrophy (2) and poliomyelitis (6). Radiographic evaluation was done by standing or sitting posteroanterior (PA) and lateral orthorontgenography. Cobb method was used for curve measurement. Global coronal balance was measured using the horizontal distance from a vertical line extended from the center of the C7 vertebral body relative to the center sacral vertebral line (CSVL) on radiographs. Pelvic obliquity was determined as the angle of the line tangent to the apices of both iliac crests to a line parallel to the floor on PA radiographs.

The mean age was 16 (5-27) years and mean follow-up was 60 (12-194) months. 13 patients were nonambulatory and 19 patients were ambulatory. Sacro-iliac and lumbar fixation was performed in 15 and 17 patients respectively. Cobb angle was improved from 66˚ (15˚-124˚) to 28,5˚ (0˚-60˚). Kyphosis was improved from 40º ((-35˚)-92˚) to 31˚ (5˚-50˚). Lordosis was improved from -36˚ ((-90˚)-90˚) to -32˚ ((-70˚)-40˚). Pelvic obliquity was improved from 18˚ (5˚-50˚) to 8,3˚ (0˚-18˚). Coronal balance improved from 4,16 (1-10) to 1,9 (1-5) cm. Pelvic tilt measurements in nonambulatory patients were significantly higher than ambulatory patients (p<0,001). Surgical intervention was successful in both groups.

Sitting balance can be obtained with lumbopelvic fusion despite some degree of residual pelvic obliquity in nonambulatory patients. Fusion of lumbar spine is adequate in ambulatory patients. Surgical treatment must be recommended and done as early as possible in the course of progressive deformity for the quality of life and success of surgery.