Artikel
Scoliosis surgery in children with cerebral palsy and neuromuscular scoliosis: Screw-Rod-System vs. Unit Rod
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Autoren
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Daniel Adler
- Universitätsklinikum Heidelberg, Zentrum für Wirbelsäulenchirurgie, Klinik für Orthopädie, Unfallchirurgie und Paraplegiologie, Heidelberg, Deutschland
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Michael Akbar
- Universitätsklinikum Heidelberg, Zentrum für Wirbelsäulenchirurgie, Klinik für Orthopädie, Unfallchirurgie und Paraplegiologie, Heidelberg, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: Infantile Cerebral Palsy (ICP), GMFCS Level V, is associated with severe scoliotic spinal deformities. Progression of pelvic and shoulder obliquity leads to the loss of sitting ability, lung and organ function are also negatively affected. Conservative treatment alone is not sufficient, but necessary for therapy. Long-segmented spondylodesis from Th2 to pelvis (os ilium) are inevitable to improve quality of life of patients. The alternative to using a screw-and-rod system is the Unit Rod in technique according to Luque-Galveston.
Methods: This is a retrospective clinical and radiological study. In 2016, a total of 9 patients (mean age 15.5 years) with neurogenic scoliosis in infantile cerebral palsy (GMFCS Level 5) were surgically corrected under intraoperative neuromonitoring. 5 patients were treated by using a conventional screw-rod system and 4 patients by using Unit Rod. The extent of correction of scoliosis angle and shoulder/pelvic obliquity were analyzed using the pre- and postoperative radiographs. Further, the operation time and the intraoperative blood loss were compared.
Results: Postoperative radiological and clinical results were determined for patients treated with Unit-Rod as well as screw-rod-system and compared with current literature. With the Unit-Rod a better correction of the pelvic obliquity compared to the screw-rod-system could be realized (83 vs 75%). Surgical time was slightly lower in Unit Rod patients (301 vs 320 minutes). The blood loss was identical (2200 vs 2250 ml), the correction of the Cobb angle slightly lower (64 vs. 73%). These results are reflected in the current literature.
Conclusion: Spondylodesis in neurogenic scoliosis using Unit-Rod has a similar potential for correction (Cobb angle, shoulder obliquity) compared with screw-rod-systems, whereby the pelvic obliquity can be addressed somewhat better. However, the sagittal profile can be corrected worse with the Unit Rod. The operation time is slightly shorter for the Unit Rod, although this procedure certainly requires a learning curve. The cost of the Unit Rod is many times lower compared to screw-rod-systems.
