Murat Oto1, Larry Holmes2, Kenneth Rogers2, Güney Yılmaz3, Petya Yorgova2, Suken A. Shah2

1Department of Orthopedics and Traumatology, Medical Faculty of Pamukkale University, Denizli, Turkey
2Department of Orthopedics and Traumatology, Nemours AI. duPont Hospital for Children, Wilmington, DE, USA
3Department of Orthopedics and Traumatology, Silvan State Hospital, Diyarbakır, Turkey

Keywords: Neuromuscular; posterior spinal fusion; scoliosis; titanium.


Objectives: In this study, we aimed to characterize the outcomes of posterior spinal fusion (PSF) using titanium instrumentation in neuromuscular scoliosis (NMS) patients with a special focus on deformity correction and correction maintenance.
Patients and methods: Between 2002 and 2004, nine patients (5 girls and 4 boys; mean age 14.9±2.3 years; range 11 to 19 years) with NMS who underwent PSF using titanium instrumentation were retrospectively analyzed. The mean height at surgery was 154.6±14.2 cm (range, 136-173 cm) and the mean weight was 59.4±19.2 kg (range, 26-114 kg). The mean follow-up duration was 3.7 years (range, 2-5 years). Preoperative data included demographics, curve type, and surgical indication. Rod size, fusion levels, duration of the operation (min), estimated blood loss (cc), and length of stay in hospital (day) were also evaluated intraoperatively. Postoperative data included correction of deformity, maintenance of correction, and complications. Radiographic measurements were obtained from standing posterior-anterior and lateral spinal radiographs at preoperative, postoperative (at first week after standing; i.e. first erect) and last follow-up visits. The data obtained were analyzed using descriptive statistic methods (mean, standard deviation, median, frequency and percentage).
Results: Dramatic improvements in the spinal deformities were observed in the patients with NMS who underwent PSF using titanium instrumentation. Mean preoperative Cobb angle was reduced from 69.7 degrees to 16.2 degrees at first erect following surgery (at first week; 77% correction). Two-year follow-up revealed that this correction sustained (mean 14.8 degrees). However, moderate to severe postoperative complications requiring careful monitoring were reported.
Conclusion: Our study results showed that PSF with titanium instrumentation in pediatric NMS patients demonstrated satisfactory outcomes during the follow-up period. However, further large-scale studies with a long-term follow-up results are required to generalize the results regarding PSF using titanium instrumentation in these patients.