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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Effect of pelvic fixation on ambulation in children with neuromuscular scoliosis
Luke Drake, Hamdi Sukkarieh, Tyler McDonald, Eldrin Bhanat, Elisa Quince, Myles Atkins, Patrick Wright, Jaysson Brooks
Luke Drake, Hamdi Sukkarieh, Eldrin Bhanat, Patrick Wright, Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MI 39110, United States
Tyler McDonald, Department of Orthopaedic Surgery, University of South Alabama, Mobile, AL 36608, United States
Elisa Quince, School of Medicine, William Carey College of Medicine, Hattiesburg, MI 39401, United States
Myles Atkins, School of Medicine, Morehouse School of Medicine, Atlanta, GE 30310, United States
Jaysson Brooks, Department of Orthopaedic Surgery, UT-Southwestern, Dallas, TX 75219, United States
Author contributions: Drake LC performed study design, x-ray measurements, statistical analysis, and manuscript preparation; Sukkarieh H contributed to study design and manuscript preparation; McDonald TC contributed to study design and manuscript preparation; Bhanat E contributed to statistical analysis and manuscript preparation; Quince E contributed to x-ray measurements and statistical analysis; Atkins M contributed to x-ray measurements and statistical analysis; Wright P contributed to study design and manuscript preparation; Brooks JT contributed to study design, statistical analysis, and manuscript preparation
Institutional review board statement: The study was reviewed and approved by the University of Mississippi Medical Center Institutional Review Board [Approval No. 2018-01610].
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: Brooks JT is a paid consultant of Depuy-Synthes, A Johnson & Johnson Company; paid consultant of OrthoPediatrics; and a paid presenter or speaker of Medtronic Spine. The remaining authors declare no conflicts of interest.
Data sharing statement: Statistical code and dataset are available from the corresponding author at jaysson.brooks@tsrh.org. Participants did not give informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jaysson Brooks, MD, Assistant Professor, Department of Orthopaedic Surgery, UT-Southwestern, 2222 Welborn Street, Dallas, TX 75219, United States. jaysson.brooks@tsrh.org
Received: March 29, 2022
Peer-review started: March 29, 2022
First decision: June 16, 2022
Revised: June 29, 2022
Accepted: July 31, 2022
Article in press: July 31, 2022
Published online: August 18, 2022
BACKGROUND
The effect of posterior spinal fusion (PSF) incorporating the pelvis on an ambulatory patient’s ability to mobilize after the fusion is not well understood.
AIM
To see whether a posterior spinal fusion with pelvic fixation using iliac or sacral alar iliac screws in ambulatory neuromuscular scoliosis (NMS) patients influences postoperative ambulatory ability.
METHODS
A retrospective review of all patients with NMS that underwent PSF with fixation incorporating the pelvis between January 1, 2012 and February 29, 2019. A total of 118 patients were eligible, including 11 ambulatory patients. The primary outcome was the maintenance of ambulatory status postoperatively. Secondary outcomes included postoperative curve magnitude, pelvic obliquity, and complications, comprising infections, instrumentation failure, and any unplanned returns to the operative room.
RESULTS
The ambulatory function was maintained in all 11 ambulatory NMS patients. One patient had an improvement in functional status with equipment-free ambulation postoperatively. An average postoperative follow-up was 19 mo. The overall complication rate was 19.4% (n = 23) with no significant differences between the groups in infection (P = 0.365), hardware failure (P = 0.505), and reoperation rate (P = 1.0). Ambulatory status did not affect complication rate (P = 0.967).
CONCLUSION
Spinal fusion to the pelvis in ambulatory patients with NMS provides effective deformity correction without the reduction in ambulatory capabilities.
Core Tip: Neuromuscular scoliosis (NMS) represents a medically and surgically complex disorder that can have a profound impact on the patient’s quality of life and the ability of their caretakers to provide adequate care. The purpose of this study is to determine whether posterior spinal fusion with pelvic fixation using iliac or sacral-alar iliac screws in ambulatory NMS patients affects postoperative ambulatory ability.
