Pediatric Orthopedic Surgery Department, University of Paris, Necker University Hospital, APHP, 149 Rue de Sevres, 75015, Paris, France; Orthopedic Surgery Department, Carlos G. Durand Hospital, Av. Diaz Velez 5044, Buenos Aires, Argentina.
Pediatric Orthopedic Surgery Department, University of Paris, Necker University Hospital, APHP, 149 Rue de Sevres, 75015, Paris, France; University Institute for Spine Surgery, Armand Trousseau Hospital, Sorbonne University, 26 avenue du Dr Netter, 75012 Paris, France.
Arch Pediatr. 2024 Aug;31(6):387-392. doi: 10.1016/j.arcped.2024.04.004. Epub 2024 Jul 14.
Neuromuscular scoliosis (NMS) is associated with an abnormal muscle tone. Traditional conservative treatments, with the historical practice of early posterior fusion, have proven ineffective. Recently, growth-sparing techniques have gained traction owing to their ability to maximize trunk height. However, these techniques have a substantial risk of complications, particularly rod breakage, with reported incidence rates ranging from 15 % to 42 %. The objective of this study was to conduct a descriptive analysis of NMS patients who experienced rod breakage following the minimally invasive fusionless surgery (MIFS) technique.
This was a single-center, retrospective study that included all NMS patients who underwent surgery between January 2015 and January 2021 and subsequently presented with rod breakage after MIFS. The MIFS technique is based on proximal fixation with double hook claws made of pedicular and -sus laminar hooks and pelvic fixation with iliosacral screws.
The mean follow-up was 5.2 ± 2.2 years. The mean dominant etiology of NMS was cerebral palsy (67 %). Of the 217 patients who underwent surgery, 15 (6.9 %) developed rod breakage. Rod breakage occurred 2.7 ± 1.3 years after the initial surgery. Four cases of rod fracture recurrence were reported in ambulatory patients with dystonia or hyperactivity.
Compared with other fusionless techniques, the minimally invasive bipolar technique appears promising for patients with NMS, with a lower rate of rod breakage. We recommend the use of a four-rod construct for ambulatory patients or for those with dystonia or hyperactivity.
神经肌肉性脊柱侧凸（NMS）与异常肌肉张力有关。传统的保守治疗方法，加上早期后路融合的历史实践，已被证明无效。最近，由于能够最大限度地增加躯干高度，保留生长的技术得到了重视。然而，这些技术有很大的并发症风险，特别是杆断裂，报告的发生率为 15%至 42%。本研究的目的是对接受微创非融合手术（MIFS）技术后发生杆断裂的 NMS 患者进行描述性分析。
这是一项单中心、回顾性研究，纳入了所有 2015 年 1 月至 2021 年 1 月期间接受手术且随后在接受 MIFS 后出现杆断裂的 NMS 患者。MIFS 技术基于使用 pedicular 和 -sus 椎板钩的双钩爪进行近端固定以及使用髂骶螺钉进行骨盆固定。
平均随访时间为 5.2±2.2 年。NMS 的主要病因是脑瘫（67%）。在接受手术的 217 例患者中，有 15 例（6.9%）发生了杆断裂。杆断裂发生在初次手术后 2.7±1.3 年。在有舞蹈症或多动的门诊患者中，有 4 例报告了杆骨折复发。
与其他非融合技术相比，微创双极技术似乎对 NMS 患者有更好的效果，杆断裂发生率较低。我们建议为活动患者或有舞蹈症或多动的患者使用四杆结构。
