Acta Chir Orthop Traumatol Cech. 2008; 75(2):117-122 | DOI: 10.55095/achot2008/020

Neuromuscular Deformity of the Pelvis and Its Surgical TreatmentOriginal papers

M. REPKO1,*, M. KRBEC1, R. CHALOUPKA1, V. TICHÝ1, A. ŠPRLÁKOVÁ-PUKOVÁ2
1 Ortopedická klinika LF MU a FN Brno-Bohunice, Univerzitní centrum pro léčbu akolióz a deformit páteře, Brno
2 Radiologická klinika LF MU a FN Brno-Bohunice

PURPOSE OF THE STUDY:
To evaluate the efficacy of surgical treatment in pelvic deformities associated with neuromuscular spine deformity, using radiographic parameters and clinical outcome analysis. In the lumbo-pelvic region, spinal deformity is most frequently combined with pelvic obliquity, lumbar hyperlordosis, hip deformity and leg-length discrepancy. Pelvic deformities include an excessive posterior or anterior pelvic tilt, obliquity or rotation and windblown hip syndrome.

MATERIAL AND METHODS:
In the period from 1994 to 2006, 42 paediatric patients (28 girls and 14 boys) underwent surgical correction of spine and pelvic deformities by the Luque-Galveston technique. The group included 25 patients with an underlying diagnosis of a spastic form of cerebral palsy, seven patients affected by paralysis, six with Duchenne muscular dystrophy and four with spinal muscular atrophy. The average age at the time of surgery was 14 years and 3 months and the patients were followed-up for 7 years and 5 months on the average. The results were evaluated on the basis of findings on antero-posterior and lateral radiographs including the pelvis, hip joints and the whole spine. The patients were examined before surgery, then immediately after it, and at yearly follow-up intervals.

RESULTS:
The mean pre-operative pelvic obliquity was 37°(+/-6.0) and it improved to 9° (+/-4.5) post-operatively. Horizontalization of the sacrum was corrected from the mean preoperative value of 19° (+/-5.0) to 37° (+/-6.1) post operatively. This difference was statistically significant (p=0.001). Scoliosis curve correction achieved by the surgery was from 79° (+/-21.3) pre-operatively to 35° (+/-14.5) post-operatively, with a mean correction rate of 56 %. The following complications were recorded: faulty insertion of the pelvic fixation resulting in perforation of the medial cortical substance of the iliac crest in one patient, pseudoarthrosis in the region of thoraco-lumbal junction in two patients, instrumentation failure with the need of pseudoarthrosis resection and re-instrumentation in one patient, and deep infection requiring wound irrigation and long-term antibiotic therapy.
DISCUSION
The surgical correction of pelvic deformity is always associated with operative treatment of scoliosis. However, the procedure is regularly preceded by surgical correction of muscular imbalance of the lower limbs and pelvis and of hip deformities. The surgical stabilization of spinal and pelvic deformities brings about the loss of some alternative motor stereotypes. This disadvantage is compensated for by a better sitting stability and better prospects for prosthetic care.

CONCLUSIONS:
The radiographic and clinical findings in the patients treated showed good correction of pelvic deformities in the frontal and sagittal planes. Pelvic obliquity correction thus contributes to the improvement of sitting stability in physically disabled patients.

Keywords: pelvic deformities, neuromuscular scoliosis, surgery

Accepted: November 12, 2007; Published: April 1, 2008  Show citation

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REPKO M, KRBEC M, CHALOUPKA R, TICHÝ V, ŠPRLÁKOVÁ-PUKOVÁ A. Neuromuscular Deformity of the Pelvis and Its Surgical Treatment. Acta Chir Orthop Traumatol Cech. 2008;75(2):117-122. doi: 10.55095/achot2008/020. PubMed PMID: 18454916.
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References

  1. ALLEN, B. L., FERGUSON, R. L.: The Galveston technique for L Rod Instrumentation of the Scoliotic Spine. Spine, 7: 276-284, 1982. Go to original source... Go to PubMed...
  2. ARLET, V., MARCHESI, D., PAPIN, P., AEBI, M.: The 'MW' sacropelvic construct: an enhanced fixation of the lumbosacral junction in neuromuscular pelvic obliquity. Europ. Spine J., 8: 229-31, 1999. Go to original source... Go to PubMed...
  3. DUBOUSSET, J.: Pelvic obluquity correction. In: Margulies, J.Y. et al.:Lumbosacral and Spinopelvic Fixation. Philadelphia, New York, Lippincott-Raven Publishers 1996.
  4. FRISCHHUT, B., KRISMER, M., STOECKL, B., LANDAUER, F., AUCKENTHALER, T.: Pelvic tilt in neuromuscular disorders. J. pediat. Orthop., 9-B: 221-8, 2000. Go to original source... Go to PubMed...
  5. GAU, Y. L., LONSTEIN, J. E., WINTER, R. B., KOOP, S., DENIS, F.: Luque-Galveston procedure for correction and stabilization of neuromuscular scoliosis and pelvic obliquity: a review of 68 patients. J. Spinal Disord., 4: 399-410, 1991. Go to original source... Go to PubMed...
  6. HUANG, M. J., LENKE, L. G.: Scoliosis and Severe Pelvic Obliquity in a Patient With Cerebral Palsy. Spine, 26: 2168-2170, 2001. Go to original source...
  7. CHALOUPKA, R., ROUBALOVÁ, J., KRBEC, M., REPKO, M., PÁTKOVÁ, J.: Vybrané kapitoly z LTV ve spondylochirurgii. IDVPZ, Brno, 2003.
  8. CHAN, K. G., GALASKO, C. S. B., DELANEY, C.: Hip subluxation and dislocation in Duchenne Muscular Dystrophy. J. pediat. Orthop., 10-B: 219-225, 2001. Go to original source...
  9. JANKOVSKÝ, J.: Ucelená rehabilitace dětí s tělesným a kombinovaným postižením. Triton 2001.
  10. KING A. G., THOMAS, K. A., EISERLOH, H. L. 3RD, MILLS, T. E., PISCIOTTA, D. N.: Analysis of the STIF technique for spino-pelvic fixation: clinical results in 19 patients with neuromuscular scoliosis. J. pediat. Orthop., 20: 667-676, 2000. Go to original source...
  11. LETTS, M., SHAPIRO, L., MULDER, K., KLASSEN, O.: The windblown hip syndrome in total body cerebral palsy. J. pediat. Orthop., 4: 55-62, 1984. Go to original source... Go to PubMed...
  12. MAC-THIONG, J. M., BERTHONNAUD, E., DIMAR, J. R., BETZ, R. R., LABELLE, H.: Sagittal alignment of the spine and pelvis during growth. Spine, 29: 1642-1647, 2004. Go to original source... Go to PubMed...
  13. MILADI, L. T., GHANEM, I. B., DRAOUI, M. M., ZELLER, R. D., DUBOUSSET, J. F.: Iliosacral screw fixation for pelvic obliquity in neuromuscular scoliosis. A long-term follow-up study. Spine, 22: 1722-1729, 1997. Go to original source... Go to PubMed...
  14. MOREAU, M., MAHOOD, J., MOREAU, K., BERG, D., HILL, D., RASO, J.: Assessing the impact of pelvic obliquity in post-operative neuromuscular scoliosis. Stud. Health Technol. Inform., 91: 481-5, 2002. Go to original source...
  15. POUL, J., VEJROSTOVÁ, M.: Triple osteotomy of the pelvis in children and adolescents. Acta Chir. orthop. Traum. čech., 68: 93-98, 2001.
  16. POUL, J., PEŠL, M., POKORNÁ, M.: Bone surgery for unstable hips in patients with cerebral palsy. Acta Chir. orthop. Traum. čech., 71: 360-365, 2004.
  17. SCHEJBALOVÁ, A.: Palliative Schanz osteotomy for irreducible hip dislocation in adolescent patients with cerebral palsy. Acta Chir. orthop. Traum. čech., 71: 281-287, 2004.
  18. SCHEJBALOVÁ, A.: Derotational subtrochanteric osteotomy of the femur in cerebral palsy patients. Acta Chir. orthop. Traum. čech., 73: 334-339, 2006. Go to original source...
  19. SMETANA, V., SCHEJBALOVÁ, A.: Importance of tenotomy of the adductors in the treatment of cerebral palsy manifestations in the lower extremities. Acta Chir. orthop. Traum. čech., 60: 301-305, 1993.
  20. TELI, M.G., CINNELLA, P., VINCITORIO, F., LOVI, A., GRAVA, G., BRAVDA-BRUNO, M.: Spinal fusion with Cotrel-Dubouset instrumentation for neuropathic scoliosis in patients with cerebral palsy. Spine, 31: E441-7, 2006. Go to original source... Go to PubMed...
  21. WILD, A., HAAK, H., KUMAR, M., KRAUSPE, R.: Is sacral instrumentation mandatory to address pelvic obliquity in neuromuscular thoracolumbar scoliosis due to myelomeningocele? Spine, 26: E325-9, 2001. Go to original source... Go to PubMed...
  22. YAZICI, M., ASHER, M.A., HARDACKER, J.W.: The safety of efficiacy of Isola-Galvestone instrumentation and arthrodesis in the treatment of neuromuscular spinal.deformities. J. Bone Jt Surg., 82-A: 524-529, 2000. Go to original source... Go to PubMed...