title: Correction of pelvic obliquity in neuromuscular spinal deformities using the "T construct": results and complications in a prospective series of 60 patients.
abstract: BACKGROUND
  We present the results of a prospective series of 60 patients treated for neuromuscular spinal deformities with an original spinopelvic construct using two sacral screws and two iliac screws. Clinical and radiological results obtained with this new surgical technique were studied and discussed according to the epidemiological data and relevant literature.
  
  
  METHODS
  From January 2008 to June 2010, the clinical data of every patient who underwent spinopelvic fixation for treatment of a neuromuscular spinal deformity were recorded prospectively.
  
  
  RESULTS
  Sixty patients were operated on during the study period. Spinal correction and fusion was performed by posterior approach. In six patients with a residual spinopelvic imbalance more than 15° on lateral preoperative bending films, an anterior release of the thoracolumbar junction was performed on the same day, before posterior correction. Preoperative pelvic obliquity (PO) ranged from 4° to 44° (mean 21.6°). Postoperative pelvic obliquity ranged from 0° to 14 (mean 4.6°). No significant loss of correction was noted at the last follow-up. One patient died 3 months after the initial procedure due to respiratory compromise. 11 patients had early postoperative infections of the posterior approach.
  
  
  CONCLUSIONS
  Despite a high rate of infectious complications, optimal correction of pelvic obliquity requires extension of spinal instrumentation to the pelvis. Spinopelvic fixation remains a difficult challenge in neurological patients with hypotrophy. We think that pelvic fixation with the "T construct" did provide effective and improved spinal stabilization in these patients, while reducing the need for a postoperative cast or brace. As a result, patients had a favourable postoperative course with early mobilization and return to a comfortable sitting position.
authors.affiliation: Department of Pediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie Paris 6, 26 Avenue du Dr. Arnold Netter, 75571, Paris Cedex 12, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Bouyer
authors.forename: Manon
authors.initials: M
authors.lastname: Bachy
authors.forename: Redoine
authors.initials: R
authors.lastname: Zahi
authors.forename: Camille
authors.initials: C
authors.lastname: Thévenin-Lemoine
authors.forename: Pierre
authors.initials: P
authors.lastname: Mary
authors.forename: Raphaël
authors.initials: R
authors.lastname: Vialle
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D002648:Child; D005260:Female; D006801:Humans; D007085:Ilium / Q000601:surgery; D008297:Male; D009468:Neuromuscular Diseases / Q000601:surgery*; D009984:Orthopedic Fixation Devices; D010388:Pelvis / Q000002:abnormalities / Q000601:surgery*; D011184:Postoperative Period; D011446:Prospective Studies; D012447:Sacrum / Q000601:surgery; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult