In nonambulatory neuromuscular scoliosis (i.e.
cerebral palsy, spinal muscle atrophy, myelomeningocoele, muscular dystrophy)
progressive scoliosis with long, sweeping curves can cause significant tipping
of the hips which can create sitting imbalance, pressure sores and pain.
12 year old female with spastic quadriplegic CP
The goal of surgical treatment for this population is
different than for the idiopathic scoliosis patient, specifically to correct
the tilt of the hips and to obtain, and maintain, a painless, well-balanced
spine above the pelvis. Hence the aim is
to establish a good sitting balance, as you see below.
Here she is now 5 years after surgery
The major challenge in the surgical correction of
neuromuscular scoliosis is how to obtain spinal correction and, secondarily,
how to maintain this alignment during the postoperative period.
Soft bones is a common problem which poses challenges
in how to obtain spinal correction.
The use of intraoperative halo-femoral traction (IHFT)
allows direct skeletal traction and correction of the spinal deformity and
pelvic obliquity.
Pulling up on the halo helps center the head over the
hips, and pulling down on the hip that is higher helps level the hips.
During the surgical procedure most, if not all, the
correction is obtained by the IHFT obviating the need for significant spinal
implant manipulation for correction.
In this 13 year old female with spastic quadriplegic
cerebral palsy, who in the second x-ray is in surgery, it is easy to see how
the scoliosis is improved and the hips more level, simply due to traction.
By off-loading the implants the chance of loosening
losing fixation at the bone-implant interface is lessened.
Here the patient is 5 years after surgery with excellent
three-dimensional spine position and a solid spine fusion.