title: Loss of correction in spinal cord injury-related scoliosis after pedicle screw fixation.
abstract: OBJECTIVE
  Spinal cord injury (SCI) in the pediatric population is an infrequent but clinically important disease to scoliosis surgeons. Spinal deformity after SCI is extremely common and almost uniformly develops in patients being injured before the growth spurt. Most treatment paradigms extrapolate management from both the adult literature as well as adolescent idiopathic scoliosis data. Since these patient populations are different in many respects, we sought out to investigate the rates of loss of correction over time as well as the factors associated with loss of correction in pediatric patients undergoing pedicle screw fixation for treatment of SCI-related scoliosis.
  
  
  METHODS
  All consecutive pediatric patients with spinal cord injury and paralytic scoliosis managed with pedicle screw constructs were identified at a single institution. Clinical and radiographic parameters were reviewed and analyzed with specific focus on parameters associated with loss of correction at an average follow-up of 2 years.
  
  
  RESULTS
  Approximately 15 % of patients had a loss of correction of greater than 10° of Cobb angle. Postoperative sagittal imbalance was found to be significantly greater in patients who lost greater than 10° of correction compared to patients who did not lose correction (53.6 ± 39.9 vs 4.3 ± 41.3 mm, p = 0.02).
  
  
  CONCLUSIONS
  Correction of patients with paralytic associated scoliosis should aim for a neutral sagittal balance in order to prevent postoperative loss of correction. Further study is needed on this subgroup of patients with scoliosis given the differences in strategies needed to correct and maintain their deformity correction.
authors.affiliation: Department of Neurosurgery, Tufts Medical Center and Floating Hospital for Children, 800 Washington St, Box #178, Boston, MA, 02111, USA.
authors.forename: Mina G
authors.initials: MG
authors.lastname: Safain
authors.forename: Steven
authors.initials: S
authors.lastname: Hwang
authors.forename: Joseph
authors.initials: J
authors.lastname: King
authors.forename: Patrick
authors.initials: P
authors.lastname: Cahill
authors.forename: Amer
authors.initials: A
authors.lastname: Samdani
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012600:Scoliosis / Q000209:etiology / Q000601:surgery*; D013119:Spinal Cord Injuries / Q000150:complications / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome