Related Experiment Video
Updated: May 9, 2025
Cell-based Assay Protocol for the Prognostic Prediction of Idiopathic Scoliosis Using Cellular Dielectric Spectroscopy
Published on: October 16, 2013
What Happens When You Wait? Larger Curves Require More Resources for Less Correction in Neuromuscular Scoliosis
Brandon Yoshida1, Jacquelyn N Valenzuela-Moss2, Tyler A Tetreault1,2
1Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California.
Study Design:
Retrospective study.
Objective:
Assess the impact of curve magnitude on the complexity of surgery, resources utilized, and outcomes during surgical management of neuromuscular scoliosis (NMS).
Background:
Despite previous attempts to determine the impact of curve magnitude on outcomes after posterior spinal fusion (PSF) in NMS, equipoise remains regarding optimal surgical timing.
Materials And Methods:
Patients aged 7 to 21 years with NMS and fusion to the pelvis at a single tertiary hospital were retrospectively reviewed. Patient demographics, surgical parameters, complications, and radiographic measurements were collected. Clinical and radiographic outcomes were compared between patients with preoperative curves ≥80° and <80°.
Results:
Three hundred thirty-seven patients met the inclusion criteria with a mean curve of 83.1° ± 26.5°. Patients with curves ≥80° had greater blood loss (994 ± 607 vs . 764 ± 535 mL, P = 0.0003), transfusion requirement (795 ± 647 vs . 478 ± 482 mL, P < 0.0001), surgical time (418 ± 117 vs . 338 ± 117 min, P < 0.0001), anesthesia time (552 ± 123 vs . 472 ± 122 min, P < 0.0001), and ICU stay (3 ± 2 vs . 2 ± 1 d, P = 0.009) compared with patients with curves <80°. Continued intubation was 2.4 times more likely (OR: 2.4; 95% CI: 1.5, 3.9; P = 0.0002) and the odds of utilizing adjunctive surgical techniques ( i.e. , intraoperative halo traction, temporary rods, and/or staged procedures) were 4 times more likely for patients with curves ≥80° (OR: 4.1; 95% CI: 2.5, 6.6; P < 0.0001). The use of spinal osteotomies was more likely among patients with larger curves (OR: 4.6; 95% CI: 2.8, 7.2; P < 0.0001). Residual curve magnitude (44.7° ± 20.5° vs . 22.6° ± 13.6°, P < 0.0001) and pelvic obliquity (10.2° ± 12.6° vs . 4.8°± 8.7°, P < 0.0001) were higher in the ≥80° group. Those with curves ≥80° were 3 times more likely to experience a change in neuromonitoring signals during surgery (OR: 3.07; 95% CI: 1.40, 6.73; P = 0.003).
Conclusion:
Curve magnitude ≥80° was associated with larger residual curves despite increased surgical complexity and greater resource utilization in the management of NMS.
