Introduction Defined as an irregular spinal curvature caused by disorders of the brain, spinal cord, and muscular system. Neurogenic curves (relative to idiopathic curves) tend to be more rapidly progressive may progress after maturity associated with pelvic obliquity are longer and involve more vertebrae (may involve cervical vertebrae) have a higher rate of pulmonary complications with surgery Classification & Treatment Outcomes surgical correction of spinal fusion is only treatment that has a documented beneficial impact on deformity parents and caretakers report excellent improvement in the child's quality of life after deformity correction Increased risk of wound complications with: Poor nutritional status (serum albumin <3.5 g/dL) Immunocompromised status (WBC <1,500 cells/ucL) Presence of a ventriculoperitoneal (VP) shunt Severe spastic quadriplegia nonambulatory status with seizures Classification and Treatment(for more detail go to disease content) Category Disease Nonoperative Treatment Operative Treatment Upper motor neuron Cerebral palsy Boston-type underarm bracing until puberty (age 10-12) and wheelchair modification Group I treat with PSF with instumentation Group II treat with PSF +/- ASF with instrumentation and fusion to pelvis (Luque-Galveston) Indications for surgery curve > 50° worsening pelvic obliquity with sitting imbalance Rett Syndrome Bracing for C-shaped curves Bracing C shaped curves Posterior Spinal Fusion indications thoracic curve that intefers with sitting and balance C shaped curves that do not respond to bracing Muscle Weakness Spinal muscular atrophy Boston-type underarm bracing until puberty (age 10-12) Treat with PSF with fusion to pelvis for improved wheelchair sitting address hip contractures before PSF may lead to temporary loss of upper extremity function Muscular dystrophy bracing is contraindicated PSF with or without fusion to pelvis (fusion to pelvis is controversial) indications absolute curve > 20° progressive curve Treat early before pulmonary function declines (curve from 20 to 30°) Paralytic Syndromes Spinal bifida and spinal cord injuries bracing is contraindicated ASF/PSF with instumentation and pelvic fixation anterior fusion required because minimal posterior element to obtain fusion Polio Boston-type underarm bracing until puberty (age 10-12) PSF
Technique Guide 10/4/2016 Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. PSF to pelvis for Neuromuscular Scoliosis Lindsay Andras David Skaggs Spine - Neuromuscular Scoliosis
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