Posterior iliac osteotomy for fixed pelvic obliquity

Area of Science:

• Pediatric Orthopedics
• Spinal Surgery
• Neurology

Background:

• Children with myelomeningocele often develop fixed pelvic obliquity due to lumbosacral scoliosis.
• This condition can lead to significant trunk imbalance and functional limitations.
• Standard surgical procedures may not effectively correct severe pelvic obliquity.

Purpose of the Study:

• To evaluate the efficacy of a bilateral posterior iliac osteotomy with bone grafting for correcting pelvic obliquity in children with myelomeningocele and scoliosis.
• To assess the long-term stability of the surgical correction.
• To document any complications associated with the procedure.

Main Methods:

• Nine children with myelomeningocele and uncorrectable lumbosacral scoliosis underwent bilateral posterior iliac osteotomy.
• A wedge of bone was transferred from the lower to the higher side of the pelvis.
• Pelvic obliquity and trunk list were measured before and after surgery.

Main Results:

• The procedure achieved a mean correction of 14 degrees (41%) in pelvic obliquity.
• Mean correction of trunk list from midline was 7 cm (69%).
• Follow-up (2-7 years) indicated permanent correction, provided scoliosis did not progress.

Conclusions:

• Bilateral posterior iliac osteotomy is an effective method for correcting severe pelvic obliquity in children with myelomeningocele and scoliosis.
• While complications like pelvic fracture and sciatic nerve palsy can occur, the procedure offers a valuable option for otherwise uncorrectable cases.
• Long-term stability is achievable with stable underlying spinal alignment.