- Email: [email protected]
Intrathecal baclofen pumps do not accelerate progression of scoliosis in quadriplegic spastic cerebral palsy
S82
Posters / The Spine Journal 16 (2016) S72–S93
STUDY DESIGN/SETTING: Retrospective multicentre study with a minimum of 2-year follow-up. PATIENT SAMPLE: Consecutive patients with EOS undergoing MCGR treatment. OUTCOME MEASURES: Clinical and radiological. METHODS: Retrospective review of prospectively collected data from consecutive patients undergoing MCGR treatment with a minimum of 2-year follow-up from six centres. Clinical data and complications noted. Radiographic measurements—thoracic kyphosis (TK), lumbar lordosis (LL) and sagittal vertical axis (SVA)—were analysed. RESULTS: 30 patients were reviewed and 23 of 30 had full radiographic data for analysis. The mean age at time of surgery was 7.3 years (range: 4–14 years) and the mean follow-up period was 39.2 months (range: 24– 61 months). Patients were divided into three groups according to preoperative TK: Group 1 (TK <20°), Group 2 (TK 20°–40°) and Group 3 (TK >40°). Mean TK did not change in Group 1 or 2 during MCGR lengthening but decreased in Group 3, and mean LL remained the same in all three groups. At final follow-up, global sagittal balance (SB) improved or returned to neutral alignment in 60% of cases, and did not change in 27% and worsened in 13%. CONCLUSIONS: This study showed that MCGR reduced TK in those with pre-existing TK >40° and had no effect on other regional sagittal parameters. It had a tendency to improve the global SB. CONFLICTS OF INTEREST: None to declare. FUNDING SOURCES: Ellipse Technology. http://dx.doi.org/10.1016/j.spinee.2016.01.112
Intrathecal baclofen pumps do not accelerate progression of scoliosis in quadriplegic spastic cerebral palsy Paul Rushton, Luigi Aurelio Nasto, Ranjit Aujila, Michael Vloeberghs, Michael Grevitt; Centre for Spinal Studies and Surgery, Queens’s Medical Centre, Nottingham BACKGROUND CONTEXT: The literature is unclear whether intrathecal baclofen (ITB) pumps accelerate scoliosis progression in cerebral palsy. PURPOSE: Compare scoliosis progression in quadriplegic spastic cerebral palsy with and without ITB pumps. STUDY DESIGN/SETTING: Retrospective matched cohort. PATIENT SAMPLE: Quadriplegic spastic cerebral palsy, Gross Motor Functional Classification System (GMFCS) level 5, follow-up >1 year. OUTCOME MEASURES: Physiologic measures: primary: annual coronal curve progression; and secondary: peak coronal curve and pelvic obliquity progression. Need for spinal fusion. METHODS: Suitable patients with ITB pumps were matched to comparable cases by age and baseline Cobb angle without ITB pumps. RESULTS: ITB group: 18 patients (8 female), mean age at pump insertion was 9.8 and Risser was 0.9. Initial Cobb angle was 24° and pelvic tilt was 1.3°. Follow-up: 4.5 (1.0–7.8) years. Cobb angle at follow-up was 77° and pelvic tilt was 20°. Non-ITB group: 18 patients (10 female), mean age at baseline was 9.7 and Risser was 1.1. Initial Cobb angle was 28° and pelvic tilt was 6°. Follow-up: 3.6 (1–7.5) years. Cobb angle at follow-up was 68° and pelvic tilt was 20°. The two groups were statistically similar for age, initial Cobb angle and Risser grade. Mean curve progression was 12.8°/ year for the ITB group versus 12.9°/year for the non-ITB group (p=.8). Peak curve progression was similar between the groups. Pelvic tilt progression was comparable: ITB group 4.7°/year versus non-ITB 4.6°/year (p=.97). 5 ITB and 6 non-ITB patients had spinal fusion surgery during follow-up. CONCLUSIONS: Patients with quadriplegic spastic cerebral palsy with and without ITB pumps showed significant curve progression over time. ITB pumps do not appear to alter the natural history of curve progression in this population. CONFLICTS OF INTEREST: No conflicts of interest. FUNDING SOURCES: No funding obtained. http://dx.doi.org/10.1016/j.spinee.2016.01.113
Sacropelvic fixation using S2 alar-iliac (S2AI) screws—analysis of clinical and radiological outcomes with minimum 1-year follow-up Sheba Basheer, Peter Loughenbury, James Tomlinson, Robert Dunsmuir, Nigel Gummerson, Almas Khan, Abhay Rao, Peter Millner; Leeds General Infirmary, Great George St, Leeds LS1 3EX BACKGROUND CONTEXT: Sacropelvic fixation with iliac screws requires transverse connectors and is associated with risks of prominent metalwork, pelvic pain, pressure necrosis and construct failure. Significant lateral dissection leads to greater risk of bleeding and infection. The S2 alar-iliac (S2AI) screw has been suggested as an alternative to reduce these risks. PURPOSE: To report the clinical and radiological outcomes of pelvic fixation using the S2AI technique in our unit. STUDY DESIGN/SETTING: Single-centre retrospective review. PATIENT SAMPLE: 21 consecutive patients undergoing sacropelvic fixation using the S2AI technique. OUTCOME MEASURES: Physiologic (radiological parameters) and selfreported (clinical outcomes). METHODS: Patients undergoing sacropelvic fixation using S2AI screws (January 2012 to October 2014) and clinical data from follow-up with radiographs at 6 months and 1 year. RESULTS: 21 patients with mean age of 61 years (range: 14–84). 13 were revision procedures with extension to the pelvis (including 3 three-column osteotomies for sagittal imbalance). 8 cases were primary procedures for adult deformity correction (3), infection (2), fracture (1), metastatic collapse (1) and syndromic scoliosis (1). One patient died due to complications of malignant disease. 20 patients were followed up for 1 year or more. There was one case of improper screw placement (sciatic notch breech— revised at 4 weeks). One patient experienced posterior pelvic pain. There were two cases of deep infection requiring further surgery and one case of aseptic screw loosening. There were no cases of screw breakage or pseudarthrosis. CONCLUSIONS: The S2AI technique is a safe and reliable method of sacropelvic fixation. Early results from our series suggest that it is associated with a low rate of complications. CONFLICTS OF INTEREST: No conflicts of interest. FUNDING SOURCES: No funding obtained. http://dx.doi.org/10.1016/j.spinee.2016.01.114
Two stage anterior/posterior scoliosis deformity correcting surgery is a powerful tool in selective lumbar fusion for stiff double major curves by saving distal motion segments H. Yu, D. Lui, A. Benton, E. Carter, J. Leong, J. Lehovsky, M. Shaw, S. Molloy, A. Gibson; Department of Spinal Disorders and Neurophysiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP BACKGROUND CONTEXT: Selective proximal lumbar fusion has clinical benefits to the patient. It is recognised that the inherent flexibility of the main thoracic (MT) curve in scoliosis is a significant predictor of final outcome of single major curves. A supine bending radiograph (SBR) can be utilised to stratify the flexibility of the thoracolumbar (TL) and MT curves in double major adolescent idiopathic scoliosis (AIS). Utilising a twostage anterior/posterior technique can save lumbar motion segments by choosing a more proximal “lowest instrumented vertebra” (LIV) compared to the traditional Harrington stable vertebra (HSV). PURPOSE: We compared the actual distal LIV and the considered HSV across a novel method of stratification into four categories of flexibility for double major curves to assess the ability of a front/back 360° procedure to ensure a selective lumbar fusion. STUDY DESIGN/SETTING: Retrospective radiographic review. PATIENT SAMPLE: 2,314 consecutive scoliosis deformity correcting surgeries from 2006 to 2012 with a minimum of 2-year follow-up identifying all AIS with front/back two-stage surgery and stratified by King Classification.
Posters / The Spine Journal 16 (2016) S72–S93
STUDY DESIGN/SETTING: Retrospective multicentre study with a minimum of 2-year follow-up. PATIENT SAMPLE: Consecutive patients with EOS undergoing MCGR treatment. OUTCOME MEASURES: Clinical and radiological. METHODS: Retrospective review of prospectively collected data from consecutive patients undergoing MCGR treatment with a minimum of 2-year follow-up from six centres. Clinical data and complications noted. Radiographic measurements—thoracic kyphosis (TK), lumbar lordosis (LL) and sagittal vertical axis (SVA)—were analysed. RESULTS: 30 patients were reviewed and 23 of 30 had full radiographic data for analysis. The mean age at time of surgery was 7.3 years (range: 4–14 years) and the mean follow-up period was 39.2 months (range: 24– 61 months). Patients were divided into three groups according to preoperative TK: Group 1 (TK <20°), Group 2 (TK 20°–40°) and Group 3 (TK >40°). Mean TK did not change in Group 1 or 2 during MCGR lengthening but decreased in Group 3, and mean LL remained the same in all three groups. At final follow-up, global sagittal balance (SB) improved or returned to neutral alignment in 60% of cases, and did not change in 27% and worsened in 13%. CONCLUSIONS: This study showed that MCGR reduced TK in those with pre-existing TK >40° and had no effect on other regional sagittal parameters. It had a tendency to improve the global SB. CONFLICTS OF INTEREST: None to declare. FUNDING SOURCES: Ellipse Technology. http://dx.doi.org/10.1016/j.spinee.2016.01.112
Intrathecal baclofen pumps do not accelerate progression of scoliosis in quadriplegic spastic cerebral palsy Paul Rushton, Luigi Aurelio Nasto, Ranjit Aujila, Michael Vloeberghs, Michael Grevitt; Centre for Spinal Studies and Surgery, Queens’s Medical Centre, Nottingham BACKGROUND CONTEXT: The literature is unclear whether intrathecal baclofen (ITB) pumps accelerate scoliosis progression in cerebral palsy. PURPOSE: Compare scoliosis progression in quadriplegic spastic cerebral palsy with and without ITB pumps. STUDY DESIGN/SETTING: Retrospective matched cohort. PATIENT SAMPLE: Quadriplegic spastic cerebral palsy, Gross Motor Functional Classification System (GMFCS) level 5, follow-up >1 year. OUTCOME MEASURES: Physiologic measures: primary: annual coronal curve progression; and secondary: peak coronal curve and pelvic obliquity progression. Need for spinal fusion. METHODS: Suitable patients with ITB pumps were matched to comparable cases by age and baseline Cobb angle without ITB pumps. RESULTS: ITB group: 18 patients (8 female), mean age at pump insertion was 9.8 and Risser was 0.9. Initial Cobb angle was 24° and pelvic tilt was 1.3°. Follow-up: 4.5 (1.0–7.8) years. Cobb angle at follow-up was 77° and pelvic tilt was 20°. Non-ITB group: 18 patients (10 female), mean age at baseline was 9.7 and Risser was 1.1. Initial Cobb angle was 28° and pelvic tilt was 6°. Follow-up: 3.6 (1–7.5) years. Cobb angle at follow-up was 68° and pelvic tilt was 20°. The two groups were statistically similar for age, initial Cobb angle and Risser grade. Mean curve progression was 12.8°/ year for the ITB group versus 12.9°/year for the non-ITB group (p=.8). Peak curve progression was similar between the groups. Pelvic tilt progression was comparable: ITB group 4.7°/year versus non-ITB 4.6°/year (p=.97). 5 ITB and 6 non-ITB patients had spinal fusion surgery during follow-up. CONCLUSIONS: Patients with quadriplegic spastic cerebral palsy with and without ITB pumps showed significant curve progression over time. ITB pumps do not appear to alter the natural history of curve progression in this population. CONFLICTS OF INTEREST: No conflicts of interest. FUNDING SOURCES: No funding obtained. http://dx.doi.org/10.1016/j.spinee.2016.01.113
Sacropelvic fixation using S2 alar-iliac (S2AI) screws—analysis of clinical and radiological outcomes with minimum 1-year follow-up Sheba Basheer, Peter Loughenbury, James Tomlinson, Robert Dunsmuir, Nigel Gummerson, Almas Khan, Abhay Rao, Peter Millner; Leeds General Infirmary, Great George St, Leeds LS1 3EX BACKGROUND CONTEXT: Sacropelvic fixation with iliac screws requires transverse connectors and is associated with risks of prominent metalwork, pelvic pain, pressure necrosis and construct failure. Significant lateral dissection leads to greater risk of bleeding and infection. The S2 alar-iliac (S2AI) screw has been suggested as an alternative to reduce these risks. PURPOSE: To report the clinical and radiological outcomes of pelvic fixation using the S2AI technique in our unit. STUDY DESIGN/SETTING: Single-centre retrospective review. PATIENT SAMPLE: 21 consecutive patients undergoing sacropelvic fixation using the S2AI technique. OUTCOME MEASURES: Physiologic (radiological parameters) and selfreported (clinical outcomes). METHODS: Patients undergoing sacropelvic fixation using S2AI screws (January 2012 to October 2014) and clinical data from follow-up with radiographs at 6 months and 1 year. RESULTS: 21 patients with mean age of 61 years (range: 14–84). 13 were revision procedures with extension to the pelvis (including 3 three-column osteotomies for sagittal imbalance). 8 cases were primary procedures for adult deformity correction (3), infection (2), fracture (1), metastatic collapse (1) and syndromic scoliosis (1). One patient died due to complications of malignant disease. 20 patients were followed up for 1 year or more. There was one case of improper screw placement (sciatic notch breech— revised at 4 weeks). One patient experienced posterior pelvic pain. There were two cases of deep infection requiring further surgery and one case of aseptic screw loosening. There were no cases of screw breakage or pseudarthrosis. CONCLUSIONS: The S2AI technique is a safe and reliable method of sacropelvic fixation. Early results from our series suggest that it is associated with a low rate of complications. CONFLICTS OF INTEREST: No conflicts of interest. FUNDING SOURCES: No funding obtained. http://dx.doi.org/10.1016/j.spinee.2016.01.114
Two stage anterior/posterior scoliosis deformity correcting surgery is a powerful tool in selective lumbar fusion for stiff double major curves by saving distal motion segments H. Yu, D. Lui, A. Benton, E. Carter, J. Leong, J. Lehovsky, M. Shaw, S. Molloy, A. Gibson; Department of Spinal Disorders and Neurophysiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP BACKGROUND CONTEXT: Selective proximal lumbar fusion has clinical benefits to the patient. It is recognised that the inherent flexibility of the main thoracic (MT) curve in scoliosis is a significant predictor of final outcome of single major curves. A supine bending radiograph (SBR) can be utilised to stratify the flexibility of the thoracolumbar (TL) and MT curves in double major adolescent idiopathic scoliosis (AIS). Utilising a twostage anterior/posterior technique can save lumbar motion segments by choosing a more proximal “lowest instrumented vertebra” (LIV) compared to the traditional Harrington stable vertebra (HSV). PURPOSE: We compared the actual distal LIV and the considered HSV across a novel method of stratification into four categories of flexibility for double major curves to assess the ability of a front/back 360° procedure to ensure a selective lumbar fusion. STUDY DESIGN/SETTING: Retrospective radiographic review. PATIENT SAMPLE: 2,314 consecutive scoliosis deformity correcting surgeries from 2006 to 2012 with a minimum of 2-year follow-up identifying all AIS with front/back two-stage surgery and stratified by King Classification.