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Pelvic obliquity in neuromuscular scoliosis: radiologic comparative results of single-stage posterior versus two-stage anterior and posterior approach

 Eun Su Moon  ;  Ankur Nanda  ;  Hak Sun Kim  ;  Sang Pil Yoon  ;  Jin Young Kim  ;  Hwan Mo Lee  ;  Seong Hwan Moon  ;  Jin Oh Park 
 Spine, Vol.36(2) : 146-152, 2011 
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STUDY DESIGN: retrospective comparative study (Level III). OBJECTIVE: to compare the operative results of posterior fusion and a 2-stage anterior L5-S1 fusion followed by posterior fusion in neuromuscular scoliosis patients with significant pelvic obliquity (PO). SUMMARY OF BACKGROUND DATA: PO in neuromuscular scoliosis is common and a challenging problem that affects proper sitting balance, necessarily addressing the deformity and proper maintenance of the correction. METHODS: a total of 54 patients with neuromuscular scoliosis and significant PO (>10°) were divided into 2 groups. Group 1 (n = 24) was operated on for posterior fusion and pelvic fixation. Group 2 (n = 30) included patients who were subjected to a first-stage procedure consisting of a lumbosacral junction release and fusion through a midline retroperitoneal approach and then a second-stage procedure of posterior fusion and pelvic fixation. Parameters measured included length of the follow-up, number of fusion levels, age at operation, forced vital capacity, operative time, estimated blood loss, and postoperative complications. Radiologic parameters measured before surgery, after surgery at the time of discharge, and at a final follow-up included Cobb angle, T1 translation, sitting pelvic obliquity (PO) in the frontal plane, C7 plumb line, thoracic kyphosis, lumbar lordosis, and sacral inclination angle in the sagittal plane. RESULTS: the correction of scoliosis was similar in both groups. The preoperative PO averaged 19.5° in Group I and 22.9° in Group II (P = 0.22), which corrected after surgery to 9.7° versus 7.4° (P = 0.23), respectively. Group II correction progressively improved significantly compared to Group I (7.0° vs. 11.6° at P = 0.046) at the latest follow-up. A 40.6% correction (mean correction = 7.9) in sitting PO in Group I compared to 70.7% correction (mean correction = 5.9°) in Group II was observed (P = 0.004). The average loss of correction of PO at the final follow-up was lesser in group II, but not statistically significant (P = 0.07). CONCLUSION: anterior fusion of the lumbosacral junction followed by posterior fusion provides superior correction and maintenance of PO in patients with neuromuscular scoliosis.
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1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실)
Yonsei Authors
김진영(Kim, Jin Young) ; 김학선(Kim, Hak Sun) ; 문성환(Moon, Seong Hwan) ; 문은수(Moon, Eun Su) ; 박진오(Park, Jin Oh) ; 이환모(Lee, Hwan Mo)
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