title: Surgical treatment using The Unit Rod in children with neuromuscular scoliosis.
abstract: The article represents a retrospective clinical and radiological study.Objective.To assess the safety and the stability in time of the Unit Rod instrumentation in the treatment of severe neuromuscular scoliosis in children and adolescents.Summary.The treatment of patients with neuromuscular scoliosis always represents a challenge. The patients are debilitated and usual interventions are very long with great loss of blood. Serious complications can compromise the result of the surgery. The technique we used (the Unit Rod) is worldwide recognized, is simple, and gives excellent stability with a low rate of complications.Methods.We conducted a clinical and radiological retrospective study with a follow-up of at least 4 years in 58 patients with serious neuromuscular conditions, most of them being non-walkers. They were surgically treated by using mostly the Unit Rod technique, in the department of Paediatric Orthopaedics of the Rouen University Hospital, France, between 2000 and 2008. The back fusion was generally from T2 to pelvis. We used the Galveston technique for the patients who needed a pelvic fixation.Results.The mean Cobb angle correction was of 67% immediately after surgery; the correction of the curve decreased in time only in 4% of the cases. Pelvic obliquity was also very well corrected: 73% immediately and 70% at the last radiological follow-up. The mean operative time was of 175 minutes compared to 269 minutes for screws and hooks instrumentation. The most common complication for our technique was the radiolucent halo that appeared around the pelvic inserts. There was no significant degradation in time of the correction obtained.Conclusions.The use of this technique is safe, gives excellent results, achieving significant improvements in the postoperative functional status of the patients. The intra- and postoperative complications were minor. The advantage of using this method is the low cost of the material and technical simplicity, the corrective results being the same as the ones obtained with other techniques.
authors.affiliation: Paediatric Surgery Department, Le Havre General Hospital, France.
authors.forename: T
authors.initials: T
authors.lastname: Nedelcu
authors.affiliation: Paediatric Orthopaedics Department, Paediatric Physical Rehabilitation Centre Bois Larris, Lamorlaye, France.
authors.forename: I
authors.initials: I
authors.lastname: Georgescu
authors.affiliation: Paediatric Surgery Department, Rouen University Hospital, France.
authors.forename: J
authors.initials: J
authors.lastname: Leroux
authors.affiliation: Paediatric Surgery Department, Rouen University Hospital, France.
authors.forename: J
authors.initials: J
authors.lastname: Lechevallier
authors.affiliation: Orthopaedics and Traumatology Department, "Carol Davila" University Emergency Military Hospital, Bucharest, Romania.
authors.forename: A
authors.initials: A
authors.lastname: Barbilian
authors.affiliation: Department of Plastic Surgery, "Carol Davila" University Emergency Military Hospital, Bucharest, Romania.
authors.forename: I
authors.initials: I
authors.lastname: Tuhar
mesh_terms: D000293:Adolescent; D002648:Child; D003710:Demography; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D009468:Neuromuscular Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D010388:Pelvis / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Unit Rod; cerebral palsy; neuro-muscular scoliosis; sublaminar wires; vertebral arthrodesis