The modified Kostuik transilial bar technique has acceptable results in neuromuscular spinal deformity correction

J Pediatr Orthop B. 2019 Jul;28(4):385-392. doi: 10.1097/BPB.0000000000000626.

Abstract

The aim of this study is to evaluate the results of the modified Kostuik transilial bar technique for neuromuscular scoliosis (NS). We reviewed the records of 21 patients treated for NS with this instrumentation. There were 14 females and seven males, with an average age of 15.6 years (range: 9-21 years). We determined patients' demographics, correction ratio of both curve and pelvic obliquity, loss of correction, screw loosening at first sacral vertebra, and clinical outcomes. Mean follow-up was 56 months (range: 34-96 months). There were no reoperations, no screw breakage, and no significant loss of correction. The mean preoperative coronal Cobb angle was 71.4°±8.7°, the initial postoperative measurements had a mean Cobb angle of 19.2°±7.2°, and at the last follow-up, the mean Cobb angle was 23.6°±6.9° (P<0.001). Pelvic obliquity decreased from 27.7°±12.4° to 9.1°±5.3° at follow-up and to 11.9°±6.3° at the last follow-up (P<0.001). The preoperative pelvic obliquity angle was significantly higher at the patients with screw loosening (P=0.016). There was one established as well as one possible pseudoarthrosis in our patients. The new technique does appear to possibly become an alternative to conventional lumbosacral fixation techniques. Integration of the bar with pipe-type connector onto the long spinal instrumentation with oblique connectors can prevent the most unenviable complications such as wide exposure, hardware prominence, reoperation, and pseudoarthrosis.

MeSH terms

  • Adolescent
  • Bone Screws / adverse effects
  • Cerebral Palsy / complications
  • Cerebral Palsy / diagnostic imaging
  • Cerebral Palsy / surgery
  • Child
  • Female
  • Follow-Up Studies
  • Humans
  • Image Processing, Computer-Assisted
  • Male
  • Meningomyelocele / complications
  • Meningomyelocele / diagnostic imaging
  • Meningomyelocele / surgery
  • Muscular Atrophy, Spinal / complications
  • Muscular Atrophy, Spinal / diagnostic imaging
  • Muscular Atrophy, Spinal / surgery
  • Muscular Dystrophy, Duchenne / complications
  • Muscular Dystrophy, Duchenne / diagnostic imaging
  • Muscular Dystrophy, Duchenne / surgery
  • Orthopedics
  • Scoliosis / complications
  • Scoliosis / diagnostic imaging
  • Scoliosis / surgery*
  • Spinal Fusion / methods*
  • Spine / abnormalities
  • Spine / surgery*
  • Young Adult