title: Posterior spinal fusion in neuromuscular scoliosis using a tibial strut graft. Results of a long-term follow-up.
abstract: METHODS
  Risks and benefits of using a tibial graft for posterior spinal fusion in neuromuscular scoliosis were evaluated in a long-term follow-up study. A consecutive series of 72 patients underwent posterior spinal fusion for neuromuscular scoliosis.
  
  
  OBJECTIVE
  Radiologic outcome was assessed to evaluate the quality of the spinal fusion. Patients were followed serially to detect donor site complications. Mean follow-up was 17 years and 8 months (minimum: 6 years, 6 months).
  
  
  BACKGROUND
  Mean age of the patients at the time of surgery was 15 years. Progression of the curvature was minimal at last follow-up (mean progression at last follow-up: lumbar curve, 4.5 degrees; thoracic curve, 5.3 degrees). Concerning donor site complications, four patients had a leg length discrepancy of less than 2 cm at last follow-up. This complication was related to tibial overgrowth at the donor site.
  
  
  METHODS
  Solid fusion was defined in this long-term study as the absence of modification of the radiologic aspect at last follow-up in addition to the presence of a massive contagious trabecular fusion mass.
  
  
  RESULTS
  The fusion appeared to be solid in all patients. No obvious pseudarthrosis could be documented. The constant successful outcome differs significantly from spinal fusion that uses bank bone. The absence of stress fracture was correlated to the low level of constraint in this essentially nonambulatory population.
  
  
  CONCLUSIONS
  This experience indicates that the tibial graft deserves consideration in posterior spinal fusion for neuromuscular scoliosis.
authors.affiliation: Department of Orthopaedic Pediatric Surgery, Hôpital Saint-Vincent-de Paul, Paris, France.
authors.forename: R D
authors.initials: RD
authors.lastname: Zeller
authors.forename: I
authors.initials: I
authors.lastname: Ghanem
authors.forename: L
authors.initials: L
authors.lastname: Miladi
authors.forename: J
authors.initials: J
authors.lastname: Dubousset
mesh_terms: D000293:Adolescent; D016025:Bone Transplantation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D009468:Neuromuscular Diseases / Q000150:complications*; D012189:Retrospective Studies; D012600:Scoliosis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013977:Tibia / Q000637:transplantation*; D013997:Time Factors