Surgical correction of paralytic neuromuscular scoliosis with poor pulmonary functions.
METHODS
A retrospective study.


OBJECTIVE
To evaluate clinical and functional success by all pedicle screw construct in paralytic neuromuscular scoliosis (NMS) with poor pulmonary functions (PFT).


BACKGROUND
Duchene muscular dystrophy and spinal muscular atrophy are often associated with poor PFT and the development of scoliosis simultaneously. Poor PFT often make surgeons reluctant to operate.


METHODS
Eighteen paralytic NMS patients who had preoperative forced vital capacity (FVC) < 30% were operated with all pedicle screw construct. Average preoperative, postoperative, and final follow-up Cobb angle, pelvic obliquity, thoracic kyphosis and lumbar lordosis, PFT (FVC% and forced expiratory volume 1%), and preoperative and follow-up functional status were analyzed. Perioperative and postoperative complications were also noted.


RESULTS
The average follow-up was 31.6 ± 7.7 months. There was significant improvement in Cobb angle (61.7%) and pelvic obliquity (56.7%), postoperatively (P < 0.001). All corrections were maintained at final follow-up. FVC was decreased from 25.2 ± 4.7% preoperatively to 24.2 ± 5.0%, 6 weeks postoperatively (P = 0.067); and on follow-up it further decreased to 20.6 ± 3.9% (P < 0.0001) (1.8%/y). Forced Expiratory Volume 1 also decreased from 22.7 ± 4.5% preoperatively to 21.8 ± 4.2% postoperatively (P = 0.037) and was 19.8 ± 3.8% at final follow-up (P < 0.0001) (1.1%/y). However, none of the patients had any respiratory complications postoperatively. Functional status was improved in 6 patients and they were able to sit without support (P = 0.027). Eight (44.4%) perioperative complications (5 pulmonary, 1 intraoperative death, and 2 others) were noticed. Postoperatively, 4 patients (23.5%) had complications; coccygodynia, back sore because of screw prominence, impingement of iliac screw, and loosening of the rod from L5 screw. All the patients were satisfied with the treatment. There were no major pulmonary complications requiring admission postoperatively.


CONCLUSIONS
Although complications are associated with the treatment of paralytic NMS, a good clinical and function outcome suggests that poor PFT should not be considered as a contraindication of scoliosis surgery.
Department of Orthopedics, Scoliosis Research Institute, Korea University Guro Hospital, Seoul, South Korea.
Hitesh N
HN
Modi
Seung-Woo
SW
Suh
Jae-Young
JY
Hong
Young-Hwan
YH
Park
Jae-Hyuk
JH
Yang
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009134:Muscular Atrophy, Spinal / Q000150:complications* / Q000503:physiopathology; D020388:Muscular Dystrophy, Duchenne / Q000150:complications* / Q000503:physiopathology; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D012189:Retrospective Studies; D012600:Scoliosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D055815:Young Adult