Abstract
Introduction: The study was to evaluate the effectiveness using a new type of instrumentation, a U-rod, in the treatment of neuromuscular scoliosis. This technique provides a method of secure fixation and excellent correction in neuromuscular curves, including correction of pelvic obliquity by terminating the rod construct in pedicle screws at Lumbar 5 without crossing the lumbosacral joint.
The need for surgery for progressive neuromuscular scoliosis is not controversial. However, often the type of instrumentation to be used is. Initially, Luque rods provided strong segmental fixation and the advent of the unit rod allowed strong segmental fixation with excellent fixation to the pelvis. However, there are cases where instrumentation to the pelvis is neither feasible nor necessary.
The U-rod offers the structural stability of a unit rod, being one continuous rod, avoiding the instability often seen with linked Luque rods, but without the need to invade the pelvis. The U-rod terminates in pedicle screws at Lumbar 4 or 5, is fixed segmentally to the remainder of the spine, and connects pelvic obliquity through the pull of the iliolumbar ligaments
Methods and Results: 11 patients have been treated with the U-rod, all for neuromuscular curves. Minimum follow-up is two years. Primary indications for use of the U-rod are: 1) ambulatory neuromuscular patient, 2) a lumbar curve with less than 15° tilt of Lumbar 5 on Sacral 1, despite the degree of pelvic obliquity, 3) a non-ambulatory neuromuscular patient meeting the above criteria for lumbar tilt/and/or pelvic obliquity.
Correction of curves has been excellent, accomplished either by posterior instrumentation alone or posterior instrumentation following anterior discectomy. The greater the degree of correction of the lumbar curve, the greater the correction of the pelvic obliquity Pelvic obliquity of up to 45° has been corrected with instrumentation to Lumbar 5 and the correction has been maintained.
Conclusions: In selected patients, the U-rod offers the ability to correct neuromuscular curves, including those with significant pelvic obliquity , without the necessity to invade the pelvis or cross the Lumbar 5 Sacral 1 joint. This is important in ambulatory neuromuscular patients. In non-ambulatory patients the unit rod offers convenience, decreased operative time, blood loss, and preserving the iliac crest for bone grafting.
Abstracts prepared by Mr J. Dorgan. Correspondence should be addressed to him at the Royal Liverpool Children’s Hospital, Alder Hey, Eaton Road, Liverpool L12 2AP, UK
President’s Lecture: Natural history and management of Congenital Kyphosis and Kyphoscoliosis M.J. McMaster, Edinburgh, Scotland, UK
Greg Houghton Lecture: Idiopathic Scoliosis – Alternatives to traditional surgery R.R. Betz, Philadelphia, USA
Instructional Lecture:New thoughts on the treatment of paralytic scoliosis R.R. Betz, Philadelphia, USA
Keynote Lectures: Idiopathic Scoliosis – How to manage the patient R.A. Dickson, Leeds, UK
Concave or convex approach for Kyphoscoliosis J. Dubousset, Paris, France Surgery or bracing for moderate AIS. How long term follow-up studies change your perspective A. Nachemson, Göteborg, Sweden
