Outcomes of scapulothoracic fusion using nonabsorbable cerclage tape fixation

Scapulothoracic (ST) fusion is an effective treatment for scapular muscle deficiency, although reported complication rates are high. The purpose of this study was to characterize the outcomes of primary and revision ST fusion using nonabsorbable suture fixation. Our hypothesis is that union rates are not diminished using this fixation strategy.

A retrospective chart review was undertaken for patients receiving ST fusion at a single institution performed by 2 surgeons from 2020 to 2024. Patient demographics, surgical technique, time to union, complications, clinical outcomes, and implant costs were recorded.

Twenty-two patients with 25 ST fusions (n = 3 bilateral) and an average follow-up of 19.9 months (standard deviation [SD] 11.9) were included for analysis. Preoperative diagnoses included facioscapulohumeral dystrophy (n = 6/22; 27%); scapulothoracic abnormal motion (STAM) with paralytic serratus anterior and/or trapezius (n = 5/22; 23%); neurogenic, functional STAM failing prior surgeries (n = 6/22; 27%); reconstruction after sarcoma resection (n = 2/22; 9%); or revision ST fusion for nonunion (n = 3/22; 14%). Fifteen patients (60%) had relevant prior surgery, with 12 of them (80%) having prior scapular or shoulder surgery. Active forward elevation (82° vs. 112°; P < .001) improved significantly after fusion whereas abduction (78° vs. 90°; P = .085), external rotation (42° vs. 38°; P = .8), and internal rotation (sacrum-L5 vs. L4-L5; P = .7) remained similar. Visual analog scale pain (5.4 vs. 2.8; P = .002) improved significantly postoperatively while Subjective Shoulder Value (22% vs. 53%; P = .085), Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (54.9 vs. 58.6; P = .15), and Patient-Reported Outcomes Measurement Information System (40.75 vs. 41.0; P = .09) remained similar. Patient satisfaction was 3.5 (SD 1.3; range 1-5) on a 5-point Likert scale. Twenty-three fusions (n = 23/25; 92%) had addition of femoral head allograft, with 1 rib autograft (4%) and 1 complete scapular allograft (4%). Average radiographic time to fusion was 27.1 (SD 23.8) weeks, with an average of 3 (SD 1.4; range 1-5) ribs fused at this time point. The number of cerclage sutures used per case was 4 (SD 2.8; range 1-11) with an average implant cost of $1,941.30 (SD $1,342.84; range $475.00-$5,225.00). There was a complication rate of 4% attributed to a nonunion, revised with iliac crest autograft with cerclage tape and resultant fusion.

Patients receiving primary or revision ST fusion using nonabsorbable cerclage sutures demonstrate high rates of fusion in this heterogenous series. Surgeons should be aware of this fixation strategy and the associated costs.