Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
T10-pelvis posterior instrumented fusion
11%
289/2750
T2-pelvis growing rod construct
22%
594/2750
T2-pelvis with posterior fusion and instrumentation
56%
1547/2750
T2-L5 posterior pedicle screw instrumented fusion
6%
174/2750
Initiate glucocorticoid treatment and postpone surgical correction for 1-2 years
3%
89/2750
Select Answer to see Preferred Response
The patient is nonambulatory with a large neuromuscular scoliosis curve with a significant L5/pelvic tilt. T2-pelvis posteriorinstrumented fusion will facilitate both curve and pelvic obliquity correction. Duchenne muscular dystrophy is a severe myopathy due to an absent dystrophin protein. There are several musculoskeletal manifestations including neuromuscular scoliosis and equinovarus foot deformities. Early posterior instrumented fusion is recommended in curves >20° due to rapid progression and respiratory decline. Fusion to the pelvis is recommended for curves >40°, pelvic tilt >10°, and lumbar curves with the apex lower than L1. Takaso et al. performed a retrospective study of 28 Duchenne muscular dystrophy patients with neuromuscular scoliosis treated with posterior pedicle screw instrumentation and fusion ending at L5. They reported patients with an L5 tilt <15° maintained a pelvic tilt correction <10° and there was satisfactory sagittal plane correction. The authors concluded posterior pedicle screw instrumentation and fusion ending at L5 is appropriate in Duchenne neuromuscular scoliosis with an L5 tilt <15° and a curve apex above L2. Arun et al. performed a non-randomized, retrospective study of 43 patients with Duchenne neuromuscular scoliosis treated with sublaminar instrumentation and spinal fusion from T2-sacrum, Hybrid T2-L5 fusion with Luque rods and sublaminar wires, or T2-L5 with pedicle screw fixation. They reported a significant increase in operative blood loss in cases with sublaminar wiring fused to the pelvis. All three type of fixation provided similar correction. Figure A is an AP radiograph of the spine demonstrating a large left-sided lumbar neuromuscular curve with the apex at L2-3 disc space and significant pelvic tilt. Incorrect answers Answer 1: A T10-pelvis instrumented fusion would not be sufficient for a neuromuscular curve. Answer 2: The use of growing rod constructs in a patient this age is not required as minimal trunk growth is remaining. Answer 4: Ending the construct at L5 is an option in certain instances. However, a patient with a significant L5a and pelvic tilt would benefit more from pelvic fixation to level the pelvis for proper sitting position. Answer 5: Postponing surgery would result in the progression of the patient's curve and further decline in respiratory function.
3.2
(5)
Please Login to add comment