Staged correction of neuromuscular scoliosis

Anterior release and fusion, combined with tong gravity traction and second stage L-rod instrumentation, establishes correctability and accomplishes circumferential arthrodesis of the spine in neuromuscular scoliosis. From March 1979 through April 1982, nine patients with neuromuscular scoliosis, with an average age of 16.4 years, underwent this two-stage surgical procedure. The parameters investigated included correction of scoliotic deformity, correction of pelvic decompensation, and spinal arthrodesis. The preoperative scoliotic curvature measured 81 degrees and the postoperative curve measured 29.3 degrees, an average correction of 63.8%. Pelvic obliquity was significant in five of nine patients, averaging 36.2 degrees preoperatively. Postoperatively the pelvic obliquity averaged 11.8 degrees, an average correction of 67.4%. One of two pelvic fixation rods rotated out of the pelvis of one patient; roentgenographically he appears to have fused without loss of correction. A second patient has a poor fusion mass by roentgenographic criteria, although she has lost no correction and has had no pain. This technique offers results comparable to other series reporting arthrodesis for neuromuscular scoliosis. It has the advantages of requiring no anterior instrumentation and no postoperative immobilization.