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

Abstract

Retrospective study. Assess the impact of curve magnitude on the complexity of surgery, resources utilized, and outcomes during surgical management of neuromuscular scoliosis (NMS). 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. Patients aged 7-21 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 pre-operative curves≥80° and <80°. 337 patients met 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 to 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). Curve magnitude≥80° was associated with larger residual curves despite increased surgical complexity and greater resource utilization in the management of NMS.