What Happens When You Wait? Larger Curves Require More Resources for Less Correction in Neuromuscular Scoliosis.

STUDY

DESIGN

Retrospective study.

OBJECTIVE

Assess the impact of curve magnitude on the complexity of surgery, resources utilized, and outcomes during surgical management of neuromuscular scoliosis (NMS).

BACKGROUND

Despite previous attempts to determine the impact of curve magnitude on outcomes after posterior spinal fusion (PSF) in NMS, equipoise remains regarding optimal surgical timing.

MATERIALS AND

METHODS

Patients aged 7 to 21 years with NMS and fusion to the pelvis at a single tertiary hospital were retrospectively reviewed. Patient demographics, surgical parameters, complications, and radiographic measurements were collected. Clinical and radiographic outcomes were compared between patients with preoperative curves ≥80° and <80°.

RESULTS

Three hundred thirty-seven patients met the inclusion criteria with a mean curve of 83.1° ± 26.5°. Patients with curves ≥80° had greater blood loss (994 ± 607 vs . 764 ± 535 mL, P = 0.0003), transfusion requirement (795 ± 647 vs . 478 ± 482 mL, P < 0.0001), surgical time (418 ± 117 vs . 338 ± 117 min, P < 0.0001), anesthesia time (552 ± 123 vs . 472 ± 122 min, P < 0.0001), and ICU stay (3 ± 2 vs . 2 ± 1 d, P = 0.009) compared with patients with curves <80°. Continued intubation was 2.4 times more likely (OR: 2.4; 95% CI: 1.5, 3.9; P = 0.0002) and the odds of utilizing adjunctive surgical techniques ( i.e. , intraoperative halo traction, temporary rods, and/or staged procedures) were 4 times more likely for patients with curves ≥80° (OR: 4.1; 95% CI: 2.5, 6.6; P < 0.0001). The use of spinal osteotomies was more likely among patients with larger curves (OR: 4.6; 95% CI: 2.8, 7.2; P < 0.0001). Residual curve magnitude (44.7° ± 20.5° vs . 22.6° ± 13.6°, P < 0.0001) and pelvic obliquity (10.2° ± 12.6° vs . 4.8°± 8.7°, P < 0.0001) were higher in the ≥80° group. Those with curves ≥80° were 3 times more likely to experience a change in neuromonitoring signals during surgery (OR: 3.07; 95% CI: 1.40, 6.73; P = 0.003).

CONCLUSION

Curve magnitude ≥80° was associated with larger residual curves despite increased surgical complexity and greater resource utilization in the management of NMS.