The feasibility, safety, and utility of vertebral wedge osteotomies for the fusionless treatment of paralytic scoliosis.

STUDY DESIGN

Before-after intervention study of a fusionless surgical technique to correct scoliosis secondary to spinal cord injury or myelodysplasia in children and adolescents.

OBJECTIVES

To determine the feasibility, safety, and utility of a fusionless treatment option for paralytic scoliosis. Once determined, these data could then be applied to develop the application of this operation for patients with other types of scoliosis, such as idiopathic.

SUMMARY OF BACKGROUND DATA

The optimal operative treatment for paralytic scoliosis remains to be determined. An ideal procedure would correct the deformity and stop the progression of scoliosis while maintaining mobility of the spine. This latter fact is important, especially for patients who rely heavily on use of trunk mobility for function.

METHODS

Fourteen patients with scoliosis secondary to spinal cord injury or myelodysplasia underwent a fusionless vertebral body wedge osteotomy procedure. Feasibility was analyzed by the ability to correct the scoliosis with the osteotomies and preserve mobility. Safety was reported by estimated blood loss, neurologic stability, and complications. Utility was reported by radiographic evidence of arrested curve progression and maintenance of spinal mobility.

RESULTS

All 14 patients successfully underwent surgery to insert the wedge-rod system, with an average initial correction of 86% (range 66%-108%). The average estimated blood loss was 1050 cc (range 300-2000 cc). There were no major complications, and no changes in spasticity, bowel or bladder patterns, or motor/sensory levels. There was no case of nonunion at the osteotomy sites. At mean follow-up of 15 months (6-29 months), 10 patients had an improvement in their Cobb magnitude, 1 patient was within 5 degrees of their initial curve, 1 patient had a worse Cobb magnitude, and in 2 patients, the curve direction reversed but still measured less than the preoperative Cobb measurement. Spinal mobility was retained in all patients, as demonstrated on side-bending radiographs.

CONCLUSIONS

The vertebral wedge osteotomy procedure appears to be a potential option for the treatment of paralytic scoliosis. The procedure was feasible and safely performed in these 14 patients, with spinal mobility maintained. There were no nonunions. The efficacy of the procedure is still not known, as is for which patients the procedure is indicated and timing of the operation. Long-term follow-up (to skeletal maturity) is needed. Only six of the patients are currently skeletally mature, and more numbers are needed to determine efficacy in this group.