Screw augmentation for spinopelvic fixation in neuromuscular spine deformities: technical note.
OBJECTIVE
The primary goal of curve correction in neuromuscular patients is to restore coronal and sagittal trunk balance, including the pelvis, to maximize sitting balance. For several years, it has been a common practice to inject polymeric cement into osteoporotic bone through specially designed, perforated pedicle screws in an effort to enhance screw stability. Therefore, we started using the association of a spinopelvic fixation with S1 pedicle screw augmentation, using bisphenol-a-glycidyl dimethacrylate composite resin in neuromuscular patients with pelvic obliquity, technique in neuromuscular patients to improve pedicle screw stability of our pelvic construct.


METHODS
Ten patients undergoing spinopelvic fixation for a neuromuscular spinal deformity were enrolled in the study. Clinical and radiographic data were analyzed and presented. Minimal follow-up took place at 6 months to assess early complications.


RESULTS
Five patients were diagnosed with spastic quadriplegia secondary to cerebral palsy, four had Duchenne's muscular dystrophy, and one had a T5-level traumatic flaccid paraplegia. Preoperative PO ranged from 8° to 34° (mean 19.16°). Postoperative PO ranged from 0° to 6.3° (mean 1.6°). After surgery, all patients returned to a full-time sitting position between days 5 and 12 without the need for additional bracing. No mechanical failure of the construct was noted during follow-up.


CONCLUSIONS
We used sacral pedicle screw augmentation as a reliable tool to strengthen spinopelvic fixation in neuromuscular scoliosis without increasing the intraoperative morbidity. In our practice, sacral screw augmentation can definitely enhance PO correction obtained by a posterior procedure.
Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris6, 26, avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France.
Arnaud
A
Dubory
Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris6, 26, avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France.|University Department for Innovative Therapies in Musculoskeletal Diseases-Armand Trousseau Hospital, The MAMUTH Hospital, 26, avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France.
Manon
M
Bachy
Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris6, 26, avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France.
Houssam
H
Bouloussa
University Clinic of Paediatric Surgery, Paediatric Orthopaedics, Hôpital Couple-Enfant, Grenoble University Hospital, Joseph-Fourier University, BP 217, 38043, Grenoble Cedex 09, France.
Aurélien
A
Courvoisier
Department of Pediatric Imaging, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris6, 26, avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France.
Baptiste
B
Morel
Department of Paediatric Orthopaedics, Armand Trousseau Hospital, Université Pierre et Marie Curie-Paris6, 26, avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France. raphael.vialle@trs.aphp.fr.|University Department for Innovative Therapies in Musculoskeletal Diseases-Armand Trousseau Hospital, The MAMUTH Hospital, 26, avenue du Docteur Arnold Netter, 75571, Paris Cedex 12, France. raphael.vialle@trs.aphp.fr.
Raphaël
R
Vialle
D000293:Adolescent; D001915:Braces; D002547:Cerebral Palsy / Q000150:complications; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D020388:Muscular Dystrophy, Duchenne / Q000150:complications; D009468:Neuromuscular Diseases / Q000150:complications*; D010264:Paraplegia / Q000150:complications; D065289:Pedicle Screws; D010384:Pelvic Bones / Q000601:surgery*; D011184:Postoperative Period; D004856:Postural Balance; D011446:Prospective Studies; D012447:Sacrum / Q000601:surgery*; D012600:Scoliosis / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*
Augmentable screw; Bisphenol-a-glycidyl dimethacrylate; Neuromuscular scoliosis; Pelvic obliquity; Spinopelvic fixation