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Sagittal Plane Deformities in Children with SMA2 following Posterior Spinal Instrumentation
Matthew A Halanski1, Rewais Hanna2, James Bernatz2
1Department of Orthopaedic Surgery, University of Nebraska Medical Center, Omaha, NE 68198, USA.
Children (Basel, Switzerland)
|August 27, 2021
Summary
Sagittal plane deformities frequently occur in children with Spinal Muscular Atrophy type 2 after spinal instrumentation. These deformities may stem from lordotic imbalance due to continued anterior growth post-surgery.
Area of Science:
- Orthopedics
- Neuromuscular Disorders
- Spinal Surgery
Background:
- Spinal Muscular Atrophy type 2 (SMA2) often requires spinal instrumentation to manage scoliosis.
- Posterior spinal instrumentation is a common surgical approach for these patients.
- Post-operative sagittal plane deformities can impact patient outcomes.
Purpose of the Study:
- To evaluate the incidence and characteristics of post-operative sagittal plane deformities in SMA2 patients treated with posterior spinal instrumentation.
- To identify potential contributing factors to the development of these deformities.
Main Methods:
- Retrospective radiographic review of 32 SMA2 patients (20 spinal fusion, 12 growing rods).
- Analysis of pre-operative, immediate post-operative, and final follow-up sagittal parameters.
- Assessment of cervical and pelvic sagittal alignment.
Main Results:
- 40% of patients developed significant sagittal deformities (tucked chin, tipped trunk).
- Sacral incidence showed a significant pre- to immediate post-operative change (p=0.03).
- Decreased thoracic kyphosis over time correlated with deformity development, leading to lordotic imbalance (p=0.001).
Conclusions:
- Sagittal plane deformities are common in SMA2 patients following posterior spinal instrumentation.
- These deformities often develop outside instrumented segments.
- Lordotic imbalance from continued anterior growth is a likely cause.
