Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2015; 6(8): 564-566
Published online Sep 18, 2015. doi: 10.5312/wjo.v6.i8.564
Neuromuscular scoliosis and pelvic fixation in 2015: Where do we stand?
Jason B Anari, David A Spiegel, Keith D Baldwin
Jason B Anari, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19102, United States
David A Spiegel, Keith D Baldwin, Children’s Hospital of Philadelphia, Philadelphia, PA 19103, United States
Author contributions: All three authors contributed equally to this paper.
Conflict-of-interest statement: The authors have no direct financial conflicts of interest to disclose. One or more of the authors has received funding outside of the submitted work from Journal of Bone and Joint Surgery (Baldwin KD), Pfizer (Baldwin KD), and Synthes Trauma (Baldwin KD).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Keith D Baldwin, MD, MPH, MSPT, Children’s Hospital of Philadelphia, 24th and Civic Center Boulevard, Philadelphia, PA 19103, United States. baldwink@email.chop.edu
Telephone: +1-856-4040653
Received: April 1, 2015
Peer-review started: April 1, 2015
First decision: June 3, 2015
Revised: June 17, 2015
Accepted: June 30, 2015
Article in press: July 2, 2015
Published online: September 18, 2015
Processing time: 170 Days and 7.3 Hours
Abstract

Neuromuscular scoliosis is a challenging problem to treat in a heterogeneous patient population. When the decision is made for surgery the surgeon must select a technique employed to correct the curve and achieve the goals of surgery, namely a straight spine over a level pelvis. Pre-operatively the surgeon must ask if pelvic fixation is worth the extra complications and infection risk it introduces to an already compromised host. Since the advent of posterior spinal fusion the technology used for instrumentation has changed drastically. However, many of the common problems seen with the unit rod decades ago we are still dealing with today with pedicle screw technology. Screw cut out, pseudoarthrosis, non-union, prominent hardware, wound complications, and infection are all possible complications when extending a spinal fusion construct to the pelvis in a neuromuscular scoliosis patient. Additionally, placing pelvic fixation in a neuromuscular patient results in extra blood loss, greater surgical time, more extensive dissection with creation of a deep dead space, and an incision that extends close to the rectum in patients who are commonly incontinent. Balancing the risk of placing pelvic fixation when the benefit, some may argue, is limited in non-ambulating patients is difficult when the literature is so mottled. Despite frequent advancements in technology issues with neuromuscular scoliosis remain the same and in the next 10 years we must do what we can to make safe neuromuscular spine surgery a reality.

Keywords: Spine; Fixation; Neuromuscular; Scoliosis; Pelvic pediatrics

Core tip: We review the historical timeline of posterior spinal fusion in neuromuscular scoliosis. Over 30 years of treatment technology to treat scoliosis has changed drastically, however, we are still not without significant post-operative complications. Questioning how we treat neuromuscular scoliosis will hopefully push our community to advance our thought processes on this complex pathology and ultimately result in improved patient outcomes.