Hefelfinger Donald C, Henningsen Joseph D, Lindsey Sierra L, Huff Scott W, Spiller Kelly, Minhas Arjun, Froehle Andrew W, Albert Michael C
Department of Orthopaedic Surgery, Corewell Health East William Beaumont University Hospital, Royal Oak, USA.
Department of Orthopaedic Surgery, Wright State University, Boonshoft School of Medicine, Dayton, USA.
Cureus. 2025 Jun 21;17(6):e86497. doi: 10.7759/cureus.86497. eCollection 2025 Jun.
Background Patients with neuromuscular scoliosis pose a challenge to surgeons due to rapid progression, diffuse vertebral involvement, osteopenia, and dysplasia. Surgical treatment of curves >50° results in high complication rates, and there remains no consensus on fixation techniques. Hybrid fixation utilizing pedicle screws and polyester sublaminar bands have been successful for surgical correction, but there is minimal data for major curves ≥85°. It's important to investigate surgical techniques in this understudied, complex patient population. This study aims to report the use and efficacy of this hybrid construct to correct curves ≥85°. Methods This is a retrospective review of pediatric neuromuscular scoliosis cases performed by three surgeons at a single institution between 2009 and 2021. Patient inclusion criteria included Cobb angle ≥85°, no previous spine surgery, and a minimum of two years of follow-up. Demographics, including comorbidities, Gross Motor Function Classification System (GMFCS) and American Society of Anesthesiologists (ASA) physical status scores, were noted preoperatively. Preoperative and postoperative angles were measured and compared using paired t-tests. Maintenance of correction was evaluated at one year and the final follow-up visit. Complications were reported for comparison with other surgical techniques. Results Twenty patients were included in the study with an average follow-up of 4.5 years. Preoperative major curves improved from an average of 100.3° to 34.1° immediately after the surgery (P<0.001). Curve correction was maintained from immediate post-op to the final follow-up in all cases. Pelvic obliquity improved from an average of 29.7° to 8.3° (P<0.001). The post-op major complication rate was 30%, requiring an additional surgery or prolonged ICU stay. Conclusions For the most severe neuromuscular scoliosis patients, the hybrid construct technique improved and maintained Cobb angles and pelvic obliquity correction at a minimum follow-up of two years. The complication rates found in this complex patient population are comparable to or less than those reported after surgical correction of lesser curves. The hybrid construct proposed maintains correction in even the most severe major curves (≥85°), making it a viable option in this complex patient population.
背景 神经肌肉型脊柱侧弯患者因病情进展迅速、椎体广泛受累、骨质减少和发育异常，给外科医生带来了挑战。对大于50°的侧弯进行手术治疗会导致高并发症发生率，并且在固定技术方面尚未达成共识。利用椎弓根螺钉和聚酯层下带的混合固定在手术矫正中已取得成功，但对于≥85°的主弯，相关数据极少。在这个研究不足的复杂患者群体中研究手术技术很重要。本研究旨在报告这种混合结构用于矫正≥85°侧弯的应用情况和疗效。
方法 这是一项对2009年至2021年间由单一机构的三位外科医生进行的小儿神经肌肉型脊柱侧弯病例的回顾性研究。患者纳入标准包括Cobb角≥85°、既往无脊柱手术史以及至少两年的随访。记录术前的人口统计学数据，包括合并症、粗大运动功能分类系统（GMFCS）和美国麻醉医师协会（ASA）身体状况评分。术前和术后角度采用配对t检验进行测量和比较。在术后一年和最后一次随访时评估矫正的维持情况。报告并发症情况以与其他手术技术进行比较。
结果 20例患者纳入研究，平均随访4.5年。术前主弯平均从100.3°改善至术后即刻的34.1°（P<0.001）。所有病例的侧弯矫正从术后即刻至最后一次随访均得以维持。骨盆倾斜度从平均29.7°改善至8.3°（P<0.001）。术后主要并发症发生率为30%，需要再次手术或延长重症监护病房住院时间。
结论 对于最严重的神经肌肉型脊柱侧弯患者，混合结构技术在至少两年的随访中改善并维持了Cobb角和骨盆倾斜度的矫正。在这个复杂患者群体中发现的并发症发生率与较小侧弯手术矫正后报告的发生率相当或更低。所提出的混合结构即使在最严重的主弯（≥85°）中也能维持矫正，使其成为这个复杂患者群体中的一个可行选择。
