title: Treatment of selected neuromuscular patients with posterior instrumentation and arthrodesis ending with lumbar pedicle screw anchorage.
abstract: METHODS
  This is a retrospective analysis of 23 patients with severe neuromuscular spinal deformity treated with posterior instrumentation and fusion ending in the lumbar spine.
  
  
  OBJECTIVE
  The purposes of this study were to determine the safety and efficacy of stopping posterior instrumentation constructs in the lumbar spine with pedicle screw anchorage.
  
  
  BACKGROUND
  There are sparse data in the peer-reviewed literature regarding indications and outcomes in patients with neuromuscular disorders for instrumented fusion ended short of the pelvis with transpedicular fixation.
  
  
  METHODS
  The average age of patients at surgery was 18.4 years (range, 10-61 years). Additional anterior discectomy and fusion were performed in four patients with large, stiff curves. No patient received anterior instrumentation. Criteria for exclusion of the pelvis from the fusion were less than 15 degrees of pelvic obliquity as a result of a compensatory curve below the major curve(s), the absence of problematic lower extremity contractures, and, often, the potential for ambulation. Process and clinical outcomes and complications were analyzed.
  
  
  RESULTS
  Radiographic follow-up was available in 21 patients at an average of 62 months (range, 24-110 months) after surgery. Their average Cobb angle was 71 degrees before surgery, 25 degrees after surgery (64% correction), and 32 degrees at follow-up (54% correction). Their average spinal-pelvic obliquity was 6 degrees before surgery, 5 degrees after surgery, and 6 degrees at follow-up. The average lower instrumented vertebra was lumbar 3.7. Clinical follow-up was available for all 23 patients for an average of 61 months (range, 24-110 months). There were no perioperative deaths, deep wound infections, pseudarthroses, or instrument failures. Outcomes based on responses to questionnaires completed by patient, parent, or caregiver were highly satisfactory in 20 patients (87%), satisfactory in 2 patients (9%) and neither satisfactory nor unsatisfactory in 1 patient (4%).
  
  
  CONCLUSIONS
  Posterior instrumentation and arthrodesis using lumbar lower instrumented vertebra pedicle screw anchorage can be performed safely and effectively, in selected patients patients with scoliosis and minimal pelvic obliquity.
authors.affiliation: Section of Orthopedics, University of Kansas Medical Center, Kansas City 66160-7387, USA.
authors.forename: C
authors.initials: C
authors.lastname: Whitaker
authors.forename: D C
authors.initials: DC
authors.lastname: Burton
authors.forename: M
authors.initials: M
authors.lastname: Asher
mesh_terms: D000293:Adolescent; D000328:Adult; D001174:Arthrodesis / Q000295:instrumentation / Q000379:methods*; D001863:Bone Screws; D002648:Child; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome