Abstract
Purpose: to analyse the outcomes of scoliosis surgery in osteogenisis imperfecta (OI) in this single–surgeon series.
Methods: Case notes of OI patients having scoliosis surgery from September 2003 were analysed.
Results: 15 patients (three male) were identified. Mean age was 15.6 years (range 10–23). There were 11 cases of OI III and 4 cases of OI IV. The mean duration of bisphosphonate treatment was 6.1 years (range 2–10). The mean BMD was 0.840 g/cm2.
There was a double-curve in 10 cases, single-curve in 5. The mean Cobb-angle was 72°.
The standard construct was a double rod with pedicle/pelvic screws at the base, double claw at the proximal end and sublaminar wires at intervening levels. The most proximal level was T1–T4 in 13 cases. Instrumentation was carried to the pelvis in 7 cases. Intra-operative fractures occurred in 5 cases.
The mean blood loss was 999 mls (range 295–5500).
Spinal cord monitoring was abnormal in 3 cases. 1 case resulted in postoperative lower limb paralysis, which recovered.
The mean hospital stay was 7.5 days. Serious postoperative complications included one case of bilateral anterior compartment syndrome and one tibial fracture.
The mean curve correction was 31%. Two cases required revision surgery: extension of fusion to the pelvis.
The mean follow-up was 22.7 months (range 4–40). There was no measurable change in position over time.
Conclusion: Scoliosis surgery in OI is effective, but may have serious complications. Fusion to the pelvis should be considered, especially in OI III.
Ethics approval: None – Audit
Interest statement: None
Correspondence should be addressed to BSS c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
