The comparison of clinical outcomes among neuromuscular scoliosis with pelvic obliquity who utilized iliac, second sacral alar-iliac and iliosacral screw fixation / 中华骨科杂志

ABSTRACT

Objective To compare the clinical outcomes of neuromuscular scoliosis(NMS)patients with pelvic obliquity who underwent spino-pelvic fixation utilized traditional iliac screw(IS),second sacral alar-iliac(S2AI)screw or iliac sacral screw. Methods All of 20 patients who met the inclusion were included in this study,with 14 cases of poliomyelitis,4 cases of spinal muscular atrophy, 2 cases of muscular dystrophy,with 11 patients utilizing IS, 6 patients utilizing S2AI,and 3 patients utilizing ISS.The radiographic parameters measured pre-and post-operation and at last follow up included coronal Cobb angle,pelvic obliq-uity,and regional kyphosis.The SRS-22 questionnaires and the Oswestry disability index(ODI)and complications were collected. Results There were no significant difference in age,Cobb angle,pelvic obliquity and regional kyphosis among three groups,the follow up times was significantly shorter in the ISS group(H=15.183,P<0.01).In the IS group,the Cobb angle at pre-or post-oper-ation and at last follow up measured 70°,35°and 40°,the pelvic obliquity measured 24°,11°and 12°,the regional kyphosis mea-sured 36°,12°and 14°.In S2AI group,the Cobb angle measured 70.5°,25.0°and 26.5°,the pelvic obliquity measured 20°,10° and 11.5°,the regional kyphosis measured 37°,12°and 12.5°,showing significant improvement compared to pre-operation(P<0.05).In the ISS group,the Cobb angle at pre or post operation and at last follow up measured 64°,25°and 27°,the pelvic obliqui-ty measured 24°,9°and 11°,the regional kyphosis measured 53°,8°and 8°,showing a decrease after surgery with P>0.05,which may attribute to the small sample size in ISS group.The pre-operative ODI score was 42%,45% in IS and S2AI group,improving significantly to 26%,25.5% at last follow up.The ODI score in ISS group improved from 36% to 24% after surgery(P=0.068).The SRS-22 score improved significantly in three groups,with P<0.05 in IS and S2AI group and P=0.066 in ISS group.In the IS group, one patient had rod breakage and underwent revision surgery,one patient had deep infection and recovered with conservative treat-ment.In the S2AI group,one patient had S2AI screw misplacement on the right side.Conclusion In the surgical management of neuromuscular scoliosis(NMS)patients with pelvic obliquity,the utilization of either iliac screw,S2AI screw or ISS fixation can ob-tain satisfied deformity correction and improvement in health-related quality of life,however,the utilization of S2AI and ISS could reduce the implant related complications.