Results and morbidity in a consecutive series of patients undergoing spinal fusion for neuromuscular scoliosis.
METHODS
A retrospective clinical and radiographic review.


OBJECTIVE
To provide current data on the results and complications of patients who have undergone spinal fusion for neuromuscular scoliosis at a center with physicians experienced in these types of cases.


BACKGROUND
The reported complication rate in the management of neuromuscular scoliosis ranges from 44% to 62% in the recent literature. This literature is that of 1991 or earlier reflecting operative techniques of the mid-1980s, and it has been used to argue against the efficacy of neuromuscular spinal fusions.


METHODS
A retrospective chart and radiographic review of 50 consecutive spinal fusions for neuromuscular scoliosis was performed at Connecticut Children's Medical Center between January 1990 and January 1994. The three most common diagnoses were spastic quadriplegic cerebral palsy (20 patients), myelomeningocele (13 patients), and muscle disease (8 patients). There were 38 posterior spinal fusions including two kyphectomies and 12 anteroposterior spinal fusions. The Luque-Galveston technique was used in 39 of 50 patients. The average age at surgery was 13 years and 6 months, with an average follow-up of 40 months (minimum, 24 months).


RESULTS
Before surgery, the mean major scoliosis measured 72 degrees, with mean best bend or traction view of 35 degrees. At most recent follow-up, the mean scoliosis magnitude was 25 degrees (mean correction, 65%). There were 17 minor complications in 14 patients and three major complications (deep wound infections) in three myelomeningocele patients. Rod breakage was noted in two patients, one of whom had an asymptomatic pseudarthrosis. There were no neurologic complications or deaths, and none of the complications affected the final results.


CONCLUSIONS
The data in the current study support the authors' belief that with current surgical techniques and perioperative management in an experienced center, the results for patients undergoing spinal fusion for neuromuscular scoliosis have been improved, and major complications have been minimized.
Benson
E R
ER
Newington Department of Orthopaedic Surgery, Connecticut Children's Medical Center, Hartford, USA.
Thomson
J D
JD
Smith
B G
BG
Banta
J V
JV
D000293:Adolescent; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D009017:Morbidity; D009468:Neuromuscular Diseases / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000706:statistics & numerical data; D013904:Thoracic Vertebrae / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome