OBJETIVE: to compare the correction of the major curve and pelvic obliquity using Luque-Galveston instrumentation and pedicle screw constructs in the treatment of neuromuscular scoliosis. METHODS: seventy-four patients treated by fusion posterior to the sacrum were investigated using preoperative, traction and postoperative radiographs. Twenty-four cases were submitted to Luque-Galveston instrumentation (Group 1) and fifty were submitted to pedicle screw fixation (Group 2). Radiographic parameters were: major curve angle in the preoperative (Cobb preop), traction (Cobb traction), and postoperative films (Cobb postop), flexibility, final correction, and the Cincinnati Index, which correlates final correction and flexibility (Cincinnati = Correctioln / Flexibility). The same parameters were analyzed for pelvic obliquity (PO): PO preop, PO traction, PO postop, Flexibility PO, Correction PO, and Cincinnati Index for PO. RESULTS: mean age in the Group 1 was 12.24 years and 16.13 years in the Group 2 (p=0.001). The commonest disease in Group 1 was spinal muscular atrophy (38%) and in Group 2, cerebral palsy (62%). The mean major curve angle was 76.67º in Group 1 and 85.54º in Group 2. Flexibility was 45.32% in Group 1 and 39.47% in Group 2. Postoperative correction was 63.07% in Group 1 and 59.8% in Group 2. Cincinnati Index was 1.44 in the Group 1 and 1.77 in the Group 2. Mean PO preop was 20.71º in Group 1 and 26.60º in Group 2. PO Flexibility was 73.61% in Group 1 and 56.54% in Group 2 (p=0.047). PO Correction was 73.47% in Group 1 and 72.11% in Group 2. Cincinnati Index for PO was 1.09 in Group 1 and 1.49 in Group 2 (p=0.045). CONCLUSIONS: postoperative major curve correction was similar with pedicle screws and Luque-Galveston instrumentation, but pelvic obliquity correction was greater when pedicle screw was used in the surgical treatment of neuromuscular scoliosis.
Spine; Scoliosis; Spinal fusion; Bone screws; Neuromuscular diseases; Treatment outcome
