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.

Introduction: Since 1989 vertebral resection with modified Luque fixation has been the procedure of choice for correction of myelomeningocele kyphotic deformity at this institution. The purpose of this study was to evaluate long-term results with this technique.

Treatment or congenital kyphosis in myelomeningocele is a difficult problem. Current thinking supports kyphectomy and post-operative internal fixation.

The majority of authors agree that kyphotic deformity in myelomeningocele should be treated with vertebral resection. There is less uniform consensus as to postoperative fixation. Literature reports appear to support fixation with modified segmental instrumentation.

Methods and Results: 16 patients, followed for an average of 57.2 months (36–94 months), underwent vertebral resection from the proximal aspect of the apical vertebra cephalad into the compensatory lordotic curve. Fixation was segmental instrumentation wired to the thoracic spine and anterior to the sacrum.

The average blood loss was 1121 cc (450–2580 cc.). Pre-operative kyphotic deformity averaged 111° (75–157°), postoperative 15° (−18° –36°) and latest follow-up of 20° (−17° –83°), with loss of correction of 6° (0–27°). Post-operative immobilisation was with a TLSO for 18 months. Complications occurred in eight of the 16 patients: (1) transient headache (2), superficial wound breakdown (2), supracondylar femur fractures (2), and one late infection secondary to skin breakdown necessitating early rod removal and some loss of correction.

Conclusions: Kyphectomy is an excellent method of correcting rigid kyphotic deformity in the myelodys-plastic patient. Segmental spinal instrumentation provides three distinct advantages: rigidity of the construct, greater correction of the deformity and low-profile instrumentation.