When Should Instrumentation to the Pelvis be Considered in Minimally Ambulatory Adolescents With Neuromuscular Scoliosis?

Autor:	Douleh DG; Department of Orthopedics, Anschutz Medical Campus., Greig D; Department of Orthopedics, University of California Los Angeles, Los Angeles, CA., Thompson R; Department of Orthopedics, University of California Los Angeles, Los Angeles, CA., Garg S; Children's Hospital Colorado, Aurora, CO.
Jazyk:	angličtina
Zdroj:	Journal of pediatric orthopedics [J Pediatr Orthop] 2021 Jul 01; Vol. 41 (Suppl 1), pp. S53-S58.
DOI:	10.1097/BPO.0000000000001821
Abstrakt:	Introduction: The goal of neuromuscular scoliosis (NMS) surgery is to improve sitting balance, facilitate daily care, and alleviate pain. In nonambulatory patients, where sitting balance is key, fusion to the pelvis is usually required. However, in minimally ambulatory patients, fusion to the pelvis remains controversial, and there is considerable practice variability in this patient population. The purpose of this study is to evaluate and summarize the available evidence regarding fusion constructs in minimally ambulatory patients with NMS and to provide expert opinion regarding when fusion to the pelvis should be considered. Methods: A search of the English literature was performed using PubMed to identify papers pertaining to patients with NMS treated with instrumented posterior spinal fusion. Papers published before 2000, case reports, and level V evidence were excluded. Results: The authors identified 8 studies for review. The majority included both nonambulatory and minimally ambulatory patients. Structured review of the literature demonstrated fusion to the pelvis may allow for greater curve and pelvic obliquity correction, but it is also associated with increased blood loss and operative time. There is no evidence that fusing to the pelvis decreases ambulatory status in minimally ambulatory patients. Conclusions: In minimally ambulatory patients with NMS, fusion short of the pelvis may be considered in patients with adequate head control without the presence of hip subluxation or dislocation and when pelvic obliquity is <15 degrees. Fusion to the pelvis is recommended in patients who do not meet these criteria. Competing Interests: S.G. reports other from ACI Clinical, other from Medtronic, other from Nuvasive, grants and other from Pediatric Orthopaedic Society of North America, grants and other from Scoliosis Research Society, other from US News and World Report Best Children’s Hospitals Orthopedics Working Group, outside the submitted work. The remaining authors declare no conflicts of interest. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu