PAPER 137: LONG-TERM OUTCOMES & COMPLICATIONS OF LUQUE UNIT ROD INSTRUMENTATION IN SURGICAL MANAGEMENT OF CEREBRAL PALSY AND NEUROMUSCULAR SCOLIOSIS

Abstract

Purpose: A retrospective review of 180 consecutive luque unit rod instrumentations for neuromuscular scoliosis revealed a low rate (7%) of reoperation for hardware related issues. The results of this cost effective instrumentation are good, and we question whether moving to more expensive systems (eg pedicle screws) will provide benefit to patients.

Method: A retrospective clinical and radiographic review of 180 consecutive patients, treated with the unit rod and sublaminar wires for progressive neuromuscular scoliosis and cerebral palsy, between 1994 and 2004 was done. Preoperative, intraoperative, and outcome data were obtained from hospital and clinic records with 2 to 12 years of followup.

Results: Mean age at surgery was 13 years. Of 180 patients, 158 were full time wheelchair users. 112 patients underwent isolated posterior surgery, 68 underwent anterior & posterior surgeries. Allograft was used in 96%. Mean surgical time was 5 hours 45 minutes, blood loss was 1325 cc. Mean cobb angles improved from 72° to 32°, pelvic obliquity improved from 20° to 9°. Overall postoperative complications were 222, with 36 (20%) of 180 patients experiencing no complication. Only 13 patients of 180 required revision surgery for hardware related problems. Pseudoarthrosis was seen in 7 patients. 18 patients had prominence of the rod. Of 22 ambulatory patients, 3 became wheelchair dependent. 8 showed coronal decompensation. Medical complications included respiratory in 52 patients, deep or superficial infection in 29, ileus in 23, UTI in 19, SMA syndrome in 5, and other in 18.

Conclusion: Although overall complications were high in this patient group, hardware related complications of the unit rod were low. Respiratory and other medical problems were most of the complications and would not be minimized with different hardware. The unit rod achieved and maintained spinal balance and fusion with only 13 hardware related revisions in 180 patients (7%).