title: Hybrid versus total pedicle screw instrumentation in patients undergoing surgery for neuromuscular scoliosis: a comparative study with matched cohorts.
abstract: We compared the clinical, radiological and quality-of-life outcomes between hybrid and total pedicle screw instrumentation in patients undergoing surgery for neuromuscular scoliosis. A matched comparison using prospectively collected data was undertaken. A total of 66 patients underwent posterior or anteroposterior correction and fusion with hybrid (n = 33, mean age at surgery 15.8 years (9.10 to 19.6)) or total pedicle screw instrumentation (n = 33, mean age 14.7 years (7.0 to 20.7)) with a minimum follow-up of two years. The major curve pre-operatively was a mean of 87° (SD 29, 25° to 141°) and 81° (SD 18, 47° to 116°) in the hybrid and total pedicle screw groups, respectively (p = 0.29) and at a minimum of two years it was 33° (SD 20; 2° to 87°) and 20° (SD 12; 1° to 55°), respectively (p = 0.0016). The mean correction of the major curve was 59% (41% to 88%) in the hybrid and 75% (43% to 99%) in the total pedicle screw groups at two-year follow-up (p = 0.0011). The mean operating time was 7.45 hours (SD 2.18) and 6.04 hours (SD 1.71) in the hybrid and total pedicle screw groups, respectively (p = 0.001), and the mean intra-operative blood loss was 3760 ml (SD 2790) and 1785 ml (SD 1110), respectively (p = 0.001). Total pedicle screw instrumentation provided shorter operating times, less blood loss and better correction of the major curve compared with hybrid constructs in patients undergoing surgery for neuromuscular scoliosis.
authors.affiliation: Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Mattila
authors.forename: T
authors.initials: T
authors.lastname: Jalanko
authors.forename: V
authors.initials: V
authors.lastname: Puisto
authors.forename: O
authors.initials: O
authors.lastname: Pajulo
authors.forename: I J
authors.initials: IJ
authors.lastname: Helenius
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D011788:Quality of Life; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation*; D055815:Young Adult