THE EFFECT OF SPINAL SURGERY ON FUNCTION IN CHILDREN WITH NEUROMOTOR DISORDERS AND SCOLIOSIS: A PROSPECTIVE STUDY USING STANDARDISED MEASURES

Abstract

Aim: The aim of this study is to prospectively evaluate the functional outcome of surgical correction in 20 patients with a significant neuromuscular scoliosis.

Method and Results: The principal objective of surgical correction of neuromuscular spinal deformity should be to maintain or improve function of the patient, but there is little evidence to support this. In wheelchair dependent patients the goal is also to maintain sitting ability, and in ambulant patients prevention of further deformity is important. Studies formally quantifying these outcome parameters have not been published with modern surgical techniques.

A consecutive series of 20 children with neuromuscu-lar scoliosis (age range 2–18 years) undergoing surgical correction were evaluated using 2 standard functional assessment tools, the Seated Postural Control Measure (SPCM) which assesses posture and function, and the Pediatric Evaluation of Disability Inventory (PEDI) which records functional ability in the domains of self-care, mobility and social function. The patients were evaluated pre-operatively and then at 2 weeks, 3 and 12 months post-operatively.

Complete data is presented for all patients at 3 months and 13 of 20 patients at 1 year follow up, the remaining data is to be collected.

The SPCM demonstrated an improvement in posture in 95% from pre-op to 2 weeks post-op, with 25% demonstrating some regression at 3 months. Most maintained or improved this at 1 year. The PEDI demonstrated a reduction in mobility at 3 months but at 1 year 60% returned to preop status.

Conclusion: Sitting position is improved by surgery, but mobility is impaired for a significant period following the correction, which may have more impact on the child’s and families life. Families need to be counselled prior to surgery about the loss of mobility and ability to self-care post operatively but that it does return by one year.