Results of Surgical Tre atment of Ne uromuscular Deformiti es of the Spine

Czech version

Authors: M. Repko ¹; M. Krbec ¹; R. Chalo upka ¹; V. Tichý ¹; A. Šprláková- puková ²
Authors‘ workplace: Ortopedická klinika LF MU a FN Brno ¹; Radi ologická klinika LF MU a FN Brno ²
Published in: Cesk Slov Neurol N 2008; 71/104(4): 472-477
Category: Short Communication

Overview

Objective:
There is an essenti al difference between ne uromuscular deformiti es of the spine and idi opathic deformiti es in terms of their nature and therape utic appro ach. Most often, we have to do with cases of paralytic or rigid kyphoscoli osis. Associ ated deformity of the pelvis may be manifested by excessive frontal or posteri or inclinati on, obliquity, rotati on or complex deformity. Based on the type of disorder, we distinguish primarily ne uropathic and myopathic deformiti es. The go al of the article is to inform abo ut the character of deformiti es, their classificati on and therape utic opti ons, and to evalu ate the effect and safety of surgical soluti on.

Pati ent and method:
We monitored the frontal and sagital plane of the spine and pelvis in a total of 42 pati ents with different ne uromuscular disorders and scoli otic deformiti es. X- ray examinati on before and after surgery with basic statistical evalu ati on was used for objective assessment of results of surgery.

Results:
The results of the X-ray analysis of the pati ents who underwent surgery showed a very go od correcti on of scoli otic deformity which resulted in an improved positi on of the pelvis both in frontal and sagital plane. The frontal plane spine correcti on was achi eved in 54% of a total of 42 operated pati ents included in the set. An improvement in all the monitored parametres (i.e. sagittal profile, T9 tilt, sagittal tilt) was achi eved in the sagittal plane. The study bro ught evidence of a significant correcti on in pelvic obliquity in the pelvic regi on, as well as of reduced excessive horizontalizati on of the sacrum. All the correcti ons achi eved had a significant effect on the improvement of the qu ality of the pati ents’ sitting and also standing positi on.

Conclusi on:
Surgical therapy of ne uromuscular deformiti es of the spine using a combinati on of Luque and Galvestone techniques corrects scoli otic curves securing stable, compensated spine and balanced pelvis witho ut further loss of motor or sense functi ons. This way, stability of the standing positi on and walking is secured, with concomitant improvement of functi onal status of the cardi o-pulmonary apparatus and overall well‑being of the affected pati ent.

Key words:
ne uromuscular – scoli osis – obliquity of the pelvis

Sources

1. Vlach O. Léčení deformit páteře. Praha: Avicenum 1986.

2. Čižmář I, Wendsche P, Brychta P, Višňa P, Kočiš J, Menšík I. Reconstructi on of functi onal handgrip in tra umatic tetraplegi a – case study. Acta Chir Plast 2003; 45(4): 119– 123.

3. Čižmář I, Wendsche P, Višňa P, Franců M, Kočiš J. Chirurgická rehabilitace horní končetiny u tetraplegických paci entů – principy a první zkušenosti. Rehabil fyz lék 2003; 2: 65– 71.

4. Hu ang MJ, Lenke LG. Scoli osis and severe pelvic obliquity in a pati ent with cerebral palsy. Spine 2001; 26(19): 2168– 2170.

5. Chan KG, Galasko CS, Delaney C. Hip subluxati on and dislocati on in Duchenne muscular dystrophy. J Pedi atr Orthop B 2001; 10(3): 219– 225.

6. Letts M, Shapiro L, Mulder K, Klassen O. The windblown hip syndrome in total body cerebral palsy. J Pedi atr Orthop 1984; 4(1): 55– 62.

7. Mac- Thi ong JM, Berthonna ud E, Dimar JR, Betz RR, Labelle H. Sagittal alignment of the spine and pelvis during growth. Spine 2004; 29(15): 1642– 1647.

8. Gupta MC, Wijesekera S, Sossan A, Martin L, Vogel LC, Bo akes JL et al. Reli ability of radi ographic parameters in ne uromuscular scoli osis. Spine 2007; 32(6): 691– 695.

9. Duval- Be a upére G, Marty C, Barthel F, Bo ise a ubert B, Bo ulay Ch, Commard MC et al. Sagittal profile of the spine prominent part of the pelvis. Stud He alth Technol Inform 2002; 88: 47– 64.

10. Sink EL, Newton PO, Mubarak SJ, Wenger DR. Maintenance of sagittal plane alignment after surgical correcti on of spinal deformity in pati ents with cerebral palsy. Spine 2003; 28(13): 1396– 1403.

11. McCall RE, Hayes B. Long- term o utcome in ne uromuscular scoli osis fused only to lumbar 5. Spine 2005; 30(18): 2056– 2060.

12. Mohamad F, Parent S, Pawelek J, Marks M, Bastrom T, Faro F et al. Peri operative complicati ons after surgical correcti on in ne uromuscular scoli osis. J Pedi atr Orthop 2007; 27(4): 392– 397.

13. Vlach O, Bílka M. Komplikace operačního léčení deformit páteře. Acta Spondylologica 2003; 2: 95– 100.

14. Sarwahi V, Sarwark JF, Schafer MF, Backer C, Lee M, King EC et al. Standards in anteri or spine surgery in pedi atric pati ents with ne uromuscular scoli osis. J Pedi atr Orthop 2001; 21(6): 756– 760.

15. Tsirikos AI, Chang WN, Dabney KW, Miller F. Comparison of one- stage versus two- stage anteroposteri or spinal fusi on in pedi atric pati ents with cerebral palsy and ne uromuscular scoli osis. Spine 2003; 28(12): 1300– 1305.

16. MacDonald DB, Al Zayed Z, Kho udeir I, Stigsby B. Monitoring scoli osis surgery with combined multiple pulse transcrani al electric motor and cortical somatosensory- evoked potenti als from the lower and upper extremiti es. Spine 2003; 28(2): 194– 203.

17. Němec M, Bednařík J, Krbec M, Mokrá M. Peroperační monitorace somatosenzorických a motorických evokovaných potenci álů u operací skoli óz. Cesk Slov Ne urol N 2006; 69/102(1): 45– 51.

18. Ko uwenhoven JW, Van Ommeren PM, Pruijs HE, Castelein RM. Spinal decompensati on in ne uromuscular dise ase. Spine 2006; 31(7): E188– E191.

19. Murphy NA, Firth S, Jorgensen T, Yo ung PC. Spinal surgery in children with idi opathic and ne uromuscular scoli osis. What‘s the difference? J Pedi atr Orthop 2006; 26(2): 216– 220.

20. Mercado E, Alman B, Wright JG. Does spinal fusi on influence qu ality of life in ne uromuscular scoli osis? Spine 2007; 32(19): S120– S125.