title: Management of spinal cord injury-related scoliosis using pedicle screw-only constructs.
abstract: OBJECTIVE
  Almost all pediatric patients who incur a spinal cord injury (SCI) will develop scoliosis, and younger patients are at highest risk for curve progression requiring surgical intervention. Although the use of pedicle screws is increasing in popularity, their impact on SCI-related scoliosis has not been described. The authors retrospectively reviewed the radiographic outcomes of pedicle screw-only constructs in all patients who had undergone SCI-related scoliosis correction at a single institution.
  
  
  METHODS
  Medical records and radiographs from Shriner's Hospital for Children-Philadelphia for the period between November 2004 and February 2011 were retrospectively reviewed.
  
  
  RESULTS
  Thirty-seven patients, whose mean age at the index surgery was 14.91±3.29 years, were identified. The cohort had a mean follow-up of 33.2±22.8 months. The mean preoperative coronal Cobb angle was 65.5°±25.7°, which corrected to 20.3°±14.4°, translating into a 69% correction (p<0.05). The preoperative coronal balance was 24.4±22.6 mm, with a postoperative measurement of 21.6±20.7 mm (p=1.00). Preoperative pelvic obliquity was 12.7°±8.7°, which corrected to 4.1°±3.8°, translating into a 68% correction (p<0.05). Preoperative shoulder balance, as measured by the clavicle angle, was 8.2°±8.4°, which corrected to 2.7°±3.1° (67% correction, p<0.05). Preoperatively, thoracic kyphosis measured 44.2°±23.7° and was 33.8°±11.5° postoperatively. Thoracolumbar kyphosis was 18.7°±12.1° preoperatively, reduced to 8.1°±7.7° postoperatively, and measured 26.8°±20.2° at the last follow-up (p<0.05). Preoperatively, lumbar lordosis was 35.3°±22.0°, which remained stable at 35.6°±15.0° postoperatively.
  
  
  CONCLUSIONS
  Pedicle screw constructs appear to provide better correction of coronal parameters than historically reported and provide significant improvement of sagittal kyphosis as well. Although pedicle screws appear to provide good radiographic results, correlation with clinical outcomes is necessary to determine the true impact of pedicle screw constructs on SCI-related scoliosis correction.
authors.affiliation: Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts; and.
authors.forename: Steven W
authors.initials: SW
authors.lastname: Hwang
authors.forename: Mina G
authors.initials: MG
authors.lastname: Safain
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: King
authors.forename: Jeff S
authors.initials: JS
authors.lastname: Kimball
authors.forename: Robert
authors.initials: R
authors.lastname: Ames
authors.forename: Randall R
authors.initials: RR
authors.lastname: Betz
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Cahill
authors.forename: Amer F
authors.initials: AF
authors.lastname: Samdani
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D065289:Pedicle Screws; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications / Q000601:surgery*; D013119:Spinal Cord Injuries / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: CSVL = central sacral vertical line; EKG = electrocardiography; MVA = motor vehicle accident; SCI = spinal cord injury; deformity; paralytic; pediatric; pedicle; scoliosis; screw